The clinical significance of detecting drainage fluid parathyroid hormone after thyroidectomy in forecasting parathyroid function_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

DONG Liying , LI Yan , LI Siqi , ZHANG Yi , ZHAO Zhijing , LIANG Ying , MAO Ying ,  MA Junfeng

Department of Thyroid-Breast Surgery, The Second Afiliated Hospital of Kunming Medical University, Kunming 650031, P. R. China;

Corresponding?author：

MA Junfeng, Email: myyjf88@163.com

Keywords：

thyroidectomy; drainage fluid parathyroid hormone; serum intact parathyroid hormone; serum calcium

DOI：

10.7507/1007-9424.201903083

Video：

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Objective To explore the clinical significance of detecting serum intact parathyroid hormone (iPTH) and drainage fluid parathyroid hormone (dPTH) after thyroidectomy in forecasting parathyroid function.Methods The clinical data of 95 thyroidectomy patients in the same treatment group from March 2018 to September 2018 were retrospectively analyzed, which in the Department of Thyroid-Breast Surgery, the Second Affiliated Hospital of Kunming Medical University. According to the surgical method, the patients were divided into 3 groups: isthmus and unilateral thyroidectomy (partial resection group, n=33), total thyroidectomy (total resection group, n=33) and total thyroidectomy and central lymph node excision (radical resection group, n=29). The negative pressure drainage tube was placed in the operative area. The iPTH and serum calcium were detected before and the first day after operation. The dPTH was detected in the first day and the second day after operation. Serum calcium, iPTH and dPTH were statistically analyzed.Results There were no significant differences in operative time, hospital stay and blood loss between the total resection group and the radical resection group (P>0.05), but the partial resection group were all less than the other two groups (P<0.01). On the first day after operation, the iPTH in the three groups were lower than that before operation, and the iPTH was significantly decreased in the total resection group and the radical resection group, with statistically significant difference (P<0.05). The dPTH in the three groups were significantly increased on the first and second day after operation (P<0.05), but there was no statistically significant difference between the three groups (P>0.05). There was no statistically significant difference in serum calcium between the three groups on the first day after operation (P>0.05).Conclusions The levels of iPTH, dPTH and serum calcium after thyroidectomy can comprehensively forecast the parathyroid function. Preventive calcium supplementation can reduce the occurrence of postoperative symptomatic hypocalcemia, which is conducive to the recovery of parathyroid function.

Citation： DONG Liying, LI Yan, LI Siqi, ZHANG Yi, ZHAO Zhijing, LIANG Ying, MAO Ying, MA Junfeng. The clinical significance of detecting drainage fluid parathyroid hormone after thyroidectomy in forecasting parathyroid function. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(10): 1196-1200. doi: 10.7507/1007-9424.201903083 Copy

1.	American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, et al. Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 2009, 19(11): 1167-1214.
2.	孫嘉偉, 許曉君, 蔡秋茂, 等. 中國甲狀腺癌發病趨勢分析. 中國腫瘤, 2013, 22(9): 690-693.
3.	中國醫師協會外科醫師分會甲狀腺外科醫師委員會. 甲狀腺手術中甲狀旁腺保護專家共識. 中國實用外科雜志, 2015, 35(7): 731-736.
4.	程若川, 艾楊卿, 刁暢. 甲狀腺手術中甲狀旁腺顯露及功能保護的臨床研究. 中國普外基礎與臨床雜志, 2009, 16(5): 351-355.
5.	閆利英, 趙瑞敏, 施秉銀. 甲狀腺術中快速甲狀旁腺素測定對預測術后低鈣血癥發生危險性的研究進展. 中華耳鼻喉頭頸外科雜志, 2006, 46(6): 474-476.
6.	周廣起, 劉新梅, 熊斌, 等. 分化型甲狀腺癌術后PTH 變化及發生低鈣血癥的臨床分析. 中國普通外科雜志, 2014, 23(5): 700-702.
7.	Del Rio P, Arcuri MF, Ferreri G, et al. The utility of serum PTH assessment 24 hours after total thyroidectomy. Otolaryngol Head Neck Surg, 2005, 132(4): 584-586.
8.	Khairy GA, Al-Saif A. Incidental parathyroidectomy during thyroid resection: incidence,risk factors, and outcome. AnnSaudi Med, 2011, 31(3): 274-278.
9.	Kim JP, Park JJ, Son HY, et al. Effectiveness of an i-PTH measurement in predicting post thyroidectomy hypocalcemia: prospective controlled study. Yonsei Med J, 2013, 54(3): 637-642.
10.	姚京, 田文. 甲狀腺全切除術后血清和術區引流液全段甲狀旁腺激素檢測的臨床意義. 中國普外基礎與臨床雜志, 2014, 21(11): 1413-1416.
11.	Gopalakrishna Iyer N, Shaha AR. Complications of thyroid surgery: prevention and management. Minerva Chir, 2010, 65(1): 71-82.
12.	Park I, Rhu J, Woo JW, et al. Preserving parathyroid gland vasculature to reduce post-thyroidectomy hypocalcemia. World J Surg, 2016, 40(6): 1382-1389.
13.	中國醫師協會外科醫師分會甲狀腺外科醫師委員會. 甲狀腺圍手術期甲狀旁腺功能保護指南(2018 版). 中國實用外科雜志, 2018, 38(10): 1108-1113.
14.	Cho JN, Park WS, Min SY. Predictors and risk factors of hypoparathyroidism after total thyroidectomy. Int J Surg, 2016, 34: 47-52.
15.	Wei T, Li Z, Jin J, et al. Autotransplantation of inferior parathyroid glands during central neck dissection for papillary thyroid carcinoma: a retrospective cohort study. Int J Surg, 2014, 12(12): 1286-1290.
16.	王平, 王勇, 曹利平. 甲狀旁腺自體移植手術方式與功能判斷. 中國實用外科雜志, 2012, 32(5): 420-422.
17.	Nemade SV, Chirmade AP. Post-thyroidectomy early serum ionic calcium level: predictor of prolonged hypocalcemia. Ear Nose Throat J, 2013, 92(8): 382-390.
18.	Singer MC, Bhakta D, Seybt MW, et al. Calcium management after thyroidectomy: a simple and cost-effective method. Otolaryngol Head Neck Surg, 2012, 146(3): 362-365.
19.	Stack BC, Bimston DN, Bodenner DL, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Reviews: postoperative hypoparathyroidism definitions and management. Endocr Pract, 2015, 21(6): 674-685.
20.	中國醫師協會外科醫師分會甲狀腺外科醫師委員會, 中國研究型醫院學會甲狀腺疾病專業委員會. 甲狀腺外科能量器械應用專家共識(2017 版). 中國實用外科雜志, 2017, 37(9): 992-997.

1. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, et al. Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 2009, 19(11): 1167-1214.
2. 孫嘉偉, 許曉君, 蔡秋茂, 等. 中國甲狀腺癌發病趨勢分析. 中國腫瘤, 2013, 22(9): 690-693.
3. 中國醫師協會外科醫師分會甲狀腺外科醫師委員會. 甲狀腺手術中甲狀旁腺保護專家共識. 中國實用外科雜志, 2015, 35(7): 731-736.
4. 程若川, 艾楊卿, 刁暢. 甲狀腺手術中甲狀旁腺顯露及功能保護的臨床研究. 中國普外基礎與臨床雜志, 2009, 16(5): 351-355.
5. 閆利英, 趙瑞敏, 施秉銀. 甲狀腺術中快速甲狀旁腺素測定對預測術后低鈣血癥發生危險性的研究進展. 中華耳鼻喉頭頸外科雜志, 2006, 46(6): 474-476.
6. 周廣起, 劉新梅, 熊斌, 等. 分化型甲狀腺癌術后PTH 變化及發生低鈣血癥的臨床分析. 中國普通外科雜志, 2014, 23(5): 700-702.
7. Del Rio P, Arcuri MF, Ferreri G, et al. The utility of serum PTH assessment 24 hours after total thyroidectomy. Otolaryngol Head Neck Surg, 2005, 132(4): 584-586.
8. Khairy GA, Al-Saif A. Incidental parathyroidectomy during thyroid resection: incidence,risk factors, and outcome. AnnSaudi Med, 2011, 31(3): 274-278.
9. Kim JP, Park JJ, Son HY, et al. Effectiveness of an i-PTH measurement in predicting post thyroidectomy hypocalcemia: prospective controlled study. Yonsei Med J, 2013, 54(3): 637-642.
10. 姚京, 田文. 甲狀腺全切除術后血清和術區引流液全段甲狀旁腺激素檢測的臨床意義. 中國普外基礎與臨床雜志, 2014, 21(11): 1413-1416.
11. Gopalakrishna Iyer N, Shaha AR. Complications of thyroid surgery: prevention and management. Minerva Chir, 2010, 65(1): 71-82.
12. Park I, Rhu J, Woo JW, et al. Preserving parathyroid gland vasculature to reduce post-thyroidectomy hypocalcemia. World J Surg, 2016, 40(6): 1382-1389.
13. 中國醫師協會外科醫師分會甲狀腺外科醫師委員會. 甲狀腺圍手術期甲狀旁腺功能保護指南(2018 版). 中國實用外科雜志, 2018, 38(10): 1108-1113.
14. Cho JN, Park WS, Min SY. Predictors and risk factors of hypoparathyroidism after total thyroidectomy. Int J Surg, 2016, 34: 47-52.
15. Wei T, Li Z, Jin J, et al. Autotransplantation of inferior parathyroid glands during central neck dissection for papillary thyroid carcinoma: a retrospective cohort study. Int J Surg, 2014, 12(12): 1286-1290.
16. 王平, 王勇, 曹利平. 甲狀旁腺自體移植手術方式與功能判斷. 中國實用外科雜志, 2012, 32(5): 420-422.
17. Nemade SV, Chirmade AP. Post-thyroidectomy early serum ionic calcium level: predictor of prolonged hypocalcemia. Ear Nose Throat J, 2013, 92(8): 382-390.
18. Singer MC, Bhakta D, Seybt MW, et al. Calcium management after thyroidectomy: a simple and cost-effective method. Otolaryngol Head Neck Surg, 2012, 146(3): 362-365.
19. Stack BC, Bimston DN, Bodenner DL, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Reviews: postoperative hypoparathyroidism definitions and management. Endocr Pract, 2015, 21(6): 674-685.
20. 中國醫師協會外科醫師分會甲狀腺外科醫師委員會, 中國研究型醫院學會甲狀腺疾病專業委員會. 甲狀腺外科能量器械應用專家共識(2017 版). 中國實用外科雜志, 2017, 37(9): 992-997.

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The clinical significance of detecting drainage fluid parathyroid hormone after thyroidectomy in forecasting parathyroid function

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