Abstract
ObjectiveSecondary hyperparathyroidism (SHPT) is a common complication of end-stage renal disease (ESRD), and part of SHPT patients need receive parathyroidectomy (PTX). However, as an important postoperative complication of SHPT, thyrotoxicosis has received little attention. Therefore, in this article, we aimed to study the status of transient thyrotoxicosis after PTX for SHPT patients with ESRD and normal thyroid function.MethodsA total of 24 SHPT patients with preoperative normal thyroid function, normal thyroglobulin (Tg) and normal thyroid antibodies receiving PTX were enrolled from the Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, from January 2017 to January 2019. Tg, high sensitivity thyrotropin stimulating hormone (sTSH), triiodothyronine (T3), free triiodothyronine (fT3), thyroxine (T4) and free thyroxine (fT4) were evaluated the day before PTX and on day 1, 3 and 5 after PTX. Besides, all enrolled patients were evaluated whether there are symptoms associated with thyrotoxicosis.ResultsAmong the 24 SHPT patients, 1 case (4.2%), 8 cases (33.3%) and 13 cases (54.2%) had suffered thyrotoxicosis at the first, third and fifth day after surgery, respectively. Serum FT4 level increased significantly from pre-operation (0.68 ± 0.15 ng/dl, normal range 0.59–1.25 ng/dl) to the third day after operation (1.91 ± 0.97 ng/dl, p<0.001) and then gradually decline. The frequencies of serum sTSH lower than the normal level gradually increased from the first day (8.3%) to fifth day (66.7%) after surgery.ConclusionTransient thyrotoxicosis is a common postoperative complication of parathyroidectomy for SHPT patients with ESRD and normal thyroid function, and it is necessary for clinicians to evaluate the perioperative thyroid function to make early diagnosis and appropriate prevention and treatment of thyrotoxicosis.
Highlights
The prevalence of chronic kidney disease (CKD) has reached 8%–16% worldwide and the prevalence of endstage renal disease (ESRD) is highly unacceptable, especially in developing countries [1, 2]
Transient thyrotoxicosis is a common postoperative complication of parathyroidectomy for Secondary hyperparathyroidism (SHPT) patients with ESRD and normal thyroid function, and it is necessary for clinicians to evaluate the perioperative thyroid function to make early diagnosis and appropriate prevention and treatment of thyrotoxicosis
As an important postoperative complication of secondary hyperparathyroidism, transient thyrotoxicosis is often ignored by clinicians
Summary
Patients A total of 24 SHPT patients with preoperative normal thyroid function receiving PTX were enrolled for analysis from Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China, from January 2017 to January 2019 (Table 1). The inclusion criteria include that SHPT patients received parathyroidectomy + auto-transplantation under the general anesthesia and all enrolled patients have been assured with the normal thyroid function, normal thyroglobulin (Tg) and normal thyroid antibodies (such as thyrotrophin receptor antibody, TRAb; thyroid peroxidase antibody, TPOAb; anti-thyroglobulin antibodies, TGAb) before surgery. Blood biological studies We assessed thyroid biochemical indicators in the morning before surgery and on day 1, 3 and 5 after surgery to compare changes in thyroid function. P value of less than 0.05 was represented statistically significant
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