Abstract
BackgroundPostoperative hypoparathyroidism is the main reason for outpatient follow-up and long-term oral calcium and calcitriol treatment. Our study investigated the influencing factors and powerful predictors of short-term postoperative parathyroid function recovery.MethodsLogistic regression was used to compare the clinicopathological characteristics; surgical details; and serum calcium (Ca), magnesium (Mg), and phosphorus (P) concentrations of patients. A receiver operating characteristic (ROC) curve was used to analyze the predictors of normal parathyroid hormone (PTH).ResultsAmong the 111 patients with PTH < 10 pg/mL on the first postoperative day, most patients experienced a return to normal PTH (PTH > 15 pg/mL) within 30 days postoperatively. Univariate analysis showed that Pod (postoperative day) 1 PTH, Pod3 PTH, Pod7 Ca, Pod7 Mg, and Pod7 P (P < 0.05) were associated with parathyroid function recovery to normal on the seventh postoperative day. Multivariate logistic regression analysis revealed the following independent risk factors for normal PTH levels at Pod7 after thyroidectomy: Pod3 PTH (P = 0.038), Pod1 PTH (P = 0.056), Pod7 Mg (P = 0.001), Pod7 P (P = 0.020), and the number of parathyroid glands in situ intraoperatively. The combined sensitivity of serum magnesium concentration and phosphorus concentration to predict parathyroid function recover to normal on the seventh postoperative day was 82.76%, with a sensitivity of 76.83%.ConclusionSerum magnesium, phosphorus and PTH concentrations are important influencing factors and effective predictors of short-term postoperative parathyroid function recovery to normal. Serum ion is an effective auxiliary diagnostic method for hypoparathyroidism after thyroidectomy.
Highlights
Postoperative hypoparathyroidism is the main reason for outpatient follow-up and long-term oral calcium and calcitriol treatment
Each patient had 3.0 parathyroid glands retained; 5 (4.50%) patients did not have any parathyroid glands retained during surgery, and 43 (38.74%) patients had all 4 parathyroid glands retained in situ
Univariate analysis showed that Pod1 parathyroid hormone (PTH) (P < 0.05), Pod3 PTH (P < 0.05), Pod7 Mg (P < 0.05), Pod7 Ca (P < 0.05), and Pod7 P (P < 0.05) were the influencing factors of parathyroid function recovery to normal on the seventh day after surgery (Table 3)
Summary
Postoperative hypoparathyroidism is the main reason for outpatient follow-up and long-term oral calcium and calcitriol treatment. Our study investigated the influencing factors and powerful predictors of short-term postoperative parathyroid function recovery. Accidental resection, thermal injury, and devascularization of the parathyroid glands are generally considered the common causes of hypoparathyroidism after thyroid surgery [4]. Calcium supplementation and calcitriol can effectively prevent the occurrence of hypocalcemia and promote the recovery of parathyroid function [8, 9]. These treatments can cause gastrointestinal discomforts, such as constipation in the short term, and increase the risk of kidney stones, gout, hypercalcemia, hypercalciuria, and hyperphosphatemia [10]. Highfrequency follow-up of patients treated with calcitriol and calcium is necessary
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