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1.
Arch. endocrinol. metab. (Online) ; 65(3): 259-264, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1285152

ABSTRACT

ABSTRACT Background: The aim of this study was to address the first cases of TOETVA done in Brazil, by TOETVA-Bra study group, regarding safety and complications. Materials and Methods: Series of the first 93 TOETVAs cases in Brazil. All authors except LPK, AJG JOR and RPT received TOETVA training including cadaveric hands-on in Thailand or United States (Johns Hopkins Medicine) during 2017. After they came back to Brazil and started doing their first TOETVA cases in the cities of Rio de Janeiro, Sao Paulo and Chapecó they agreed to collaborate and gather data using an online spreadsheet. All patients were submitted to the technique described by Anuwong. Results: A total of 93 patients underwent TOETVA. Most patients (58.1%) were submitted to total thyroidectomy and 59.1% had benign disease. Two patients (2.2%) needed conversion to open surgery. Five patients (9.3%) developed transient hypoparathyroidism and there were 3 (2.0%) temporary recurrent laryngeal nerve palsy. There was one (0.7%) permanent unilateral palsy. Twenty patients had some sort of complication, 16.1% were minor and 5.4% were major. A total of 73 patients (78.5%) had an uneventful recovery. Conclusion: The technique is reproducible with a low complication rate. While further studies are needed to confirm equivalency, early efforts suggest that TOETVA is not inferior to traditional open thyroidectomy in appropriately selected patients.


Subject(s)
Humans , Thyroidectomy/adverse effects , Hypoparathyroidism , Brazil , Endoscopy , Learning Curve
2.
Rev. Col. Bras. Cir ; 48: e20202557, 2021. tab, graf
Article in English | LILACS | ID: biblio-1155373

ABSTRACT

ABSTRACT The thyroidectomy is the most frequently executed procedure in head and neck surgery. Since its first description by Kocher, the transverse cervical incision has been the main access to the thyroid site, as it provides broad exposure of the central neck compartment. Despite the meticulous suture of the incision, the development of a scar with variable dimensions is unavoidable and, hence, some patients might not agree to the approach, due to this consequence. The transoral endoscopic thyroidectomy vestibular access (TOETVA) gains importance as an alternative to the traditional surgery, since it avoids the formation of visible scars. The objective of this study is to develop a systematic review on the currently available literature to evaluate possible complications related to the TOETVA. The systematic review was based on the databases of Medline, Cochrane library, Embase and Scielo/Lilacs, resulting in the selection of six studies, which were compared in regard of the type of study duration of the study and identified complications. Our study showed that TOETVA is related to complications similar to the ones identified in the conventional approach, such as hematoma, seroma, recurrent laryngeal nerve injury, hypoparathyroidism, surgical site infection. The TOETVA was associated to a higher risk of thermic injury of the skin and mentual nerve paresthesia. Moreover, it was possible to conclude that TOETVA is a safe procedure for well selected patients, with favorable conditions and concerned about the aesthetic outcome. The risk of complications of the procedure should always be explained to those patients.


RESUMO A tireoidectomia é o procedimento cirúrgico mais frequentemente realizado na cirurgia de cabeça e pescoço. Desde sua descrição por Kocher, a incisão cervical transversa constitui o principal acesso à loja tireoideana e permite ampla exposição à região central do pescoço. Apesar do fechamento meticuloso da incisão, uma cicatriz de dimensões variáveis é inevitável, e certos pacientes podem discordar de tal abordagem. A tireoidectomia vestibular endoscópica transoral (TOETVA) ganha importância como alternativa à cirurgia tradicional, pois evita a formação de cicatrizes visíveis. O objetivo de estudo é realizar uma revisão sistemática da literatura das possíveis complicações da TOETVA. Foi realizada revisão sistemática da literatura nas bases de dados Medline, The Cochrane Library, Embase e SciElo/Lilacs, sendo selecionados seis artigos e tabulados os dados de tipo de estudo, período do estudo e complicações apresentadas. O estudo mostra que a TOETVA apresenta complicações semelhantes à técnica convencional, como hematoma, seroma, lesão de nervo laríngeo recorrente, hipoparatireoidismo, além de infecção de sítio cirúrgico, com maior risco de lesão térmica da pele e parestesia por lesão do nervo mentual. Em adição, foi possível concluir que a TOETVA é uma técnica segura para pacientes bem selecionados, com condições favoráveis e com especial preocupação com resultados estéticos, devendo sempre ser orientados sobre possíveis complicações.


Subject(s)
Humans , Thyroid Gland/surgery , Thyroidectomy/methods , Natural Orifice Endoscopic Surgery/adverse effects , Hypoparathyroidism/surgery , Postoperative Complications , Thyroidectomy/adverse effects , Hematoma
3.
Rev. CEFAC ; 23(3): e13920, 2021. tab, graf
Article in English | LILACS | ID: biblio-1155339

ABSTRACT

ABSTRACT Purpose: to estimate the prevalence of voice- and swallowing-related symptoms in women submitted to total thyroidectomy. Methods: a population-based, observational, cross-sectional, analytical study, based on a Brazilian national survey. A total of 252 women, aged 18 to 58 years, submitted to total thyroidectomy, residing in the five geographical regions of the country participated in the study. All of them answered the version of the Thyroidectomy-Related Voice Questionnaire translated and adapted into Brazilian Portuguese, besides questions on demographic and clinical issues. A descriptive analysis of the categorical and quantitative variables was conducted. The relationship between the total TVQ score and the independent variables was analyzed with the Mann-Whitney and Kruskal-Wallis tests. The significance level used was 5%. Results: the most prevalent symptoms were, tired voice, after talking for a long time (50%), and dry mouth/thirst (43.3%). The voice-related symptoms were more prevalent than those related to swallowing. The total TVQ score was not related to age group (p=0.141), profession (p=0.213), region of residence (p=0.303), time since surgery (p=0.955), and radiotherapy/radioiodine therapy (p=0.666). Conclusion: Brazilian women submitted to total thyroidectomy have a high prevalence of voice- and swallowing-related symptoms, the former being predominant.


RESUMO Objetivo: estimar a prevalência de sintomas relacionados à voz e deglutição em mulheres submetidas à tireoidectomia total. Métodos: estudo de base populacional, observacional, transversal e analítico, baseado em um survey nacional brasileiro. Participaram do estudo 252 mulheres submetidas à tireoidectomia total, com idades entre 18 e 58 anos, residentes nas cinco regiões geográficas do país. Todas responderam a versão traduzida e adaptada para o português brasileiro do Thyroidectomy-Related Voice Questionnaire (TVQ), além de questões demográficas e clínicas. Foi realizada análise descritiva das variáveis categóricas e quantitativas. A relação entre escore total do TVQ e variáveis independentes foi analisada por meio dos testes de Mann-Whitney e Kruskal-Wallis. O nível de significância foi de 5%. Resultados: os sintomas mais prevalentes foram sensação de voz cansada depois de conversar por muito tempo (50%) e percepção de boca seca/sede (43,3%). Sintomas vocais foram mais prevalentes que os relacionados à deglutição. O escore total do TVQ não se relacionou com faixa etária (p=0,141), profissão (p=0,213), região de residência (p=0,303), tempo de cirurgia (p=0,955) e radioterapia/radioiodoterapia (p=0,666). Conclusão: mulheres brasileiras submetidas à tireoidectomia total possuem alta prevalência de sintomas relacionados à voz e deglutição, com predomínio dos sintomas vocais seguidos dos sintomas relacionados à deglutição.


Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Thyroidectomy/adverse effects , Deglutition Disorders/etiology , Voice Disorders/etiology , Socioeconomic Factors , Prevalence , Cross-Sectional Studies , Surveys and Questionnaires , Risk Factors
4.
Rev. Assoc. Med. Bras. (1992) ; 66(11): 1573-1576, Nov. 2020. tab
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1143630

ABSTRACT

SUMMARY INTRODUCTION: Obesity is a growing public health problem associated with many comorbid diseases. The aim of this study was to evaluate the relationship between body mass index and complications of thyroidectomy. METHODS: Patients who underwent total thyroidectomy between January 2015 and December 2018 were enrolled. Patients were divided into two groups, i.e., BMI <25 (group A) and BMI≥ 25 (group B). Demographics, operative time, and complications were retrospectively reviewed. RESULTS: The study included 145 patients (66 in Group A and 79 in Group B). There was no significant difference between the two groups in terms of age (p=0.330) and gender (p=0.055). No surgical site infection and bleeding complications were observed in any patients. The mean operative time was 148.4 minutes (90-235) in Group A and 153.4 minutes (85-285) in Group B (p=0.399). Transient hypocalcemia was observed in 25 (37.9%) patients in group A, and 23 (29.1%) patients in Group B (p = 0.291). Permanent hypocalcemia was not observed in any patient in group A, and in 2 patients in Group B (2.5%) (p = 0.501). Transient recurrent nerve palsy was observed in 1 (1.5%) patient in Group A and in 3 (3.8%) patients in Group B (p=0.626). None of the patients had permanent recurrent nerve palsy. Parathyroid autotransplantation was performed on 1 patient (1.5%) in group A and on 7 (8.9%) patients in Group B (p=0.055). CONCLUSION: We think there is no relationship between a high BMI and thyroidectomy complications, and surgery can also be performed safely in this patient group.


RESUMO INTRODUÇÃO: A obesidade é um crescente problema de saúde pública associado a muitas doenças comórbidas. O objetivo deste estudo foi avaliar a relação entre o índice de massa corporal e as complicações da tireoidectomia. MÉTODOS: Os pacientes submetidos a tireoidectomia total entre janeiro de 2015 e dezembro de 2018 foram incluidos. Os pacientes foram divididos em dois como IMC <25 (grupo A) e IMC . 25 (grupo B). Demografia, tempo operatorio e complicacoes revisadas retrospectivamente. RESULTADOS: O estudo incluiu 145 pacientes (66 no grupo A e 79 no grupo B). Não houve diferença significativa entre os dois grupos em termos de idade (p = 0,033) e sexo (p = 0,055). Nenhuma infecção do sítio cirúrgico e complicações hemorrágicas foram observadas em nenhum paciente. O tempo operatório médio foi de 148,4 minutos (90-235) no grupo A e 153,4 minutos (85-285) no grupo B (p = 0,399). Hipocalcemia transitória foi observada em 25 (37,9%) pacientes do grupo A e 23 (29,1%) do grupo B (p = 0,291). Hipocalcemia permanente não foi observada em nenhum paciente do grupo A e em 2 pacientes do grupo B (2,5%) (p = 0,501). Paralisia nervosa recorrente transitória foi observada em 1 (1,5%) paciente no grupo A e em 3 (3,8%) pacientes no grupo B (p = 0,626). Nenhum dos pacientes apresentou paralisia nervosa recorrente permanente. O autotransplante de paratireóide foi realizado em 1 paciente (1,5%) no grupo A e em 7 (8,9%) pacientes no grupo B (p = 0,055). CONCLUSÃO:: Acreditamos que não há relação entre um IMC alto e as complicações da tireoidectomia e a cirurgia pode ser realizada com segurança também neste grupo de pacientes.


Subject(s)
Humans , Male , Female , Thyroidectomy/adverse effects , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Body Mass Index , Retrospective Studies , Operative Time , Hypocalcemia/etiology
5.
Medicina (B.Aires) ; 80(3): 289-291, jun. 2020. graf, tab
Article in Spanish | LILACS | ID: biblio-1125082

ABSTRACT

El hipoparatiroidismo (hipoPTH) es una enfermedad infrecuente caracterizada por hipocalcemia y niveles inapropiadamente bajos o ausentes de parathormona. Presentamos el caso de un hombre de 25 años, deportista de alto rendimiento, con antecedente de hipoPTH secundario a tiroidectomía total dos años antes por cáncer papilar multifocal bilateral tiroideo, estadificado como T3 N1b M0, derivado por hipocalcemia sintomática. Presentaba calcemias promedio de 7mg%, síntomas de hipocalcemia en reposo y múltiples internaciones. Inicialmente, se optimizó tratamiento convencional con aporte de calcio vía oral hasta 12g/día, vitamina D y calcitriol, sin mejoría clínica ni bioquímica. Se descartaron malabsorción y complicaciones crónicas de hipoPTH. Se evidenció a través de cuestionario de salud SF-36 disminución de la calidad de vida. Se indicó sustitución con parathormona recombinante humana [rhPTH(1-84)] 50μg/día subcutánea con posterior ascenso a 75μg y reducción progresiva de la medicación por vía oral. Actualmente se encuentra asintomático, sin requerimiento de calcio ni vitamina D, mantiene calcemias de 9mg%, realiza actividad deportiva y demuestra marcada mejoría en la calidad de vida según cuestionario SF-36 (36-Item Short Form Health Survey).


Hypoparathyroidism (HypoPT) is a rare disease characterized by low calcium and inappropriately low circulating parathormone levels. We present the case of a 25-year-old high-performance athlete male, with history of HypoPT after total thyroidectomy for papillary thyroid carcinoma (T3 N1b M0) two years before, who was referred to our clinic for symptomatic hypocalcemia. The patient reported serum calcium average levels of 7mg%, presented symptoms of hypocalcemia at rest and had multiple hospital admissions. First, standard treatment was optimized by calcium supplementation up to 12g/d and active vitamin D, not showing clinical or biochemical improvement. Malabsorption and complications of chronic HypoPT were ruled out. The 36-Item Short Form Health Survey (SF-36) demonstrated an impaired quality of life (QoL). Full-length recombinant human parathyroid hormone [rhPTH(1-84)] therapy was started with 50μg/d subcutaneous, and later adjusted to 75μg/d and the oral treatment gradually decreased. Currently, he is asymptomatic, with serum calcium levels above 9mg%, without receiving oral medication. He performs sports activity and shows marked improvement in quality of life according to SF-36 questionnaire.


Subject(s)
Humans , Male , Adult , Parathyroid Hormone/therapeutic use , Hypoparathyroidism/drug therapy , Thyroidectomy/adverse effects , Vitamin D/therapeutic use , Calcitriol/therapeutic use , Thyroid Neoplasms/surgery , Thyroid Neoplasms/complications , Hormone Replacement Therapy/methods , Calcium-Regulating Hormones and Agents/therapeutic use , Thyroid Cancer, Papillary/surgery , Thyroid Cancer, Papillary/complications , Hypoparathyroidism/etiology
6.
Rev. argent. cir ; 112(1): 9-15, mar. 2020. graf, tab
Article in English, Spanish | LILACS | ID: biblio-1125776

ABSTRACT

Antecedentes: la hipocalcemia es la complicación más frecuente luego de una tiroidectomía total y puede manifestarse de manera bioquímica, o con síntomas leves o severos. Objetivos: analizar factores de riesgo asociados al desarrollo de hipocalcemia severa postiroidectomía total. Material y métodos: se incluyeron pacientes en los que se realizó tiroidectomía total primaria, analizando factores de riesgo asociados al desarrollo de hipocalcemia severa (signos y síntomas que requirieron internación y tratamiento con calcio intravenoso o persistencia de signosintomatología luego de 48 horas de haber recibido tratamiento inicial vía oral). Se analizaron variables demográficas, clínico-quirúrgicas e histopatológicas. Resultados: se realizaron un total de 1665 tiroidectomías entre 2007 y 2018 y, de estas, 918 fueron tiroidectomías totales primarias. Un total de 203 (22%) pacientes desarrollaron hipocalcemia. De ellos, 183 (20%) presentaron hipocalcemia leve y 20 (2%) hipocalcemia severa. En el análisis univariado, la edad, la intervención por cirujano especialista en cabeza y cuello, el peso de la glándula tiroides mayor de 30 gramos, la resección paratiroidea y la patología maligna se vieron asociados al desarrollo de hipocalcemia severa. En el análisis multivariado, los últimos tres fueron factores de riesgo asociados a esta complicación, con significancia estadística. Conclusiones: en nuestra serie, los factores de riesgo asociados al desarrollo de hipocalcemia severa postiroidectomía total fueron la resección, advertida o inadvertida de las glándulas paratiroides, el peso de la glándula tiroides mayor de 30 gramos y la patología maligna. Por lo tanto, en estos pacientes debemos prestar especial atención al desarrollo de dicha complicación en el posoperatorio.


Background: Hypocalcemia is the most common complication after a total thyroidectomy. It may occur as biochemical hypocalcemia, or with mild or severe symptoms. Objectives: The aim of this study was to analyze the risk factors associated with the development of severe hypocalcemia after total thyroidectomy. Material and methods: Patients undergoing primary total thyroidectomy were included. The risk factors for the development of severe hypocalcemia (signs and symptoms requiring hospitalization and treatment with intravenous calcium or persistence of signs and symptoms after 48 hours of initial oral treatment) were analyzed. The evaluation included analysis of the demographic, clinical, surgical and histopathological variables. Results: Of 1665 thyroid resections performed between 2007 and 2018, 918 corresponded to primary total thyroidectomies; 203 (22%) of these patients developed hypocalcemia. Mild hypocalcemia occurred in 183 (20%) cases and sever hypocalcemia in 20 (2%) patients, The univariate analysis showed that a procedure performed by head and neck surgeons, thyroid gland weight > 30 g, resection of the parathyroid glands and thyroid cancer were associated with the development of severe hypocalcemia. On multivariate analysis, the last three variables were risk factors significantly associated with this complication. Conclusions: In our series, noticed or inadvertent resection of the parathyroid glands with subsequent reimplantation, high weight of the thyroid gland and malignancy were identified as risk factors for the development of severe hypocalcemia after total thyroidectomy. Therefore, we should pay special attention to the development of such complication in the postoperative period.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Thyroidectomy/adverse effects , Risk Factors , Hypocalcemia/pathology , Postoperative Complications/drug therapy , Calcium , Prospective Studies , Retrospective Studies , Clinical Laboratory Techniques/methods
8.
Säo Paulo med. j ; 137(3): 241-247, May-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1020959

ABSTRACT

ABSTRACT BACKGROUND: The relationship between preoperative vitamin D deficiency and postoperative hypocalcemia in cases of total thyroidectomy (TT) is a matter of controversy and may vary according to geographical scenarios and populations. OBJECTIVE: The objective here was to evaluate whether preoperative vitamin D deficiency was associated with postoperative symptomatic hypocalcemia in a population in South America. DESIGN AND SETTING: Retrospective cohort study on data from all patients undergoing total thyroidectomy, with or without central compartment lymph node dissection, from January 2014 to December 2017, at the A. C. Camargo Cancer Center. METHODS: Patients with benign thyroid disease (Graves' disease, multinodular goiter or hyperthyroidism) or thyroid cancer who underwent primary total thyroidectomy with or without central compartment lymph node dissection were included. The exclusion criteria were simultaneous parathyroidectomy and conditions that could affect serum calcium levels. The data collected included patient demographics, thyroid pathology, extent of the surgical procedure and complications. Information on preoperative and postoperative calcium, parathyroid hormone (PTH) and vitamin D levels were retrieved from the medical records. RESULTS: 1,347 patients were assessed and postoperative hypocalcemia was diagnosed in 284 patients (21%). The vitamin D levels were considered deficient in 243 patients (18%). Postoperative hypocalcemia was diagnosed in 357 patients (31.5%). Multivariate analysis showed that central compartment dissection and preoperative total calcium and deficient vitamin D levels were significant risk factors for postoperative hypocalcemia. CONCLUSION: Deficient preoperative vitamin D levels were a significant risk factor for postoperative hypocalcemia. Preoperative oral supplementation should be considered, to minimize this risk.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Thyroid Diseases/surgery , Thyroidectomy/adverse effects , Vitamin D Deficiency/complications , Hypocalcemia/etiology , Postoperative Complications , Preoperative Care , Retrospective Studies , Risk Factors
9.
Braz. j. otorhinolaryngol. (Impr.) ; 85(1): 3-10, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-984058

ABSTRACT

Abstract Introduction: Dysphonia is a common symptom after thyroidectomy. Objective: To analyze the vocal symptoms, auditory-perceptual and acoustic vocal, videolaryngoscopy, the surgical procedures and histopathological findings in patients undergoing thyroidectomy. Methods: Prospective study. Patients submitted to thyroidectomy were evaluated as follows: anamnesis, laryngoscopy, and acoustic vocal assessments. Moments: pre-operative, 1st post (15 days), 2nd post (1 month), 3rd post (3 months), and 4th post (6 months). Results: Among the 151 patients (130 women; 21 men). Type of surgery: lobectomy + isthmectomy n = 40, total thyroidectomy n = 88, thyroidectomy + lymph node dissection n = 23. Vocal symptoms were reported by 42 patients in the 1st post (27.8%) decreasing to 7.2% after 6 months. In the acoustic analysis, f0 and APQ were decreased in women. Videolaryngoscopies showed that 144 patients (95.3%) had normal exams in the preoperative moment. Vocal fold palsies were diagnosed in 34 paralyzes at the 1st post, 32 recurrent laryngeal nerve (lobectomy + isthmectomy n = 6; total thyroidectomy n = 17; thyroidectomy + lymph node dissection n = 9) and 2 superior laryngeal nerve (lobectomy + isthmectomy n = 1; Total thyroidectomy + lymph node dissection n = 1). After 6 months, 10 patients persisted with paralysis of the recurrent laryngeal nerve (6.6%). Histopathology and correlation with vocal fold palsy: colloid nodular goiter (n = 76; palsy n = 13), thyroiditis (n = 8; palsy n = 0), and carcinoma (n = 67; palsy n = 21). Conclusion: Vocal symptoms, reported by 27.8% of the patients on the 1st post decreased to 7% in 6 months. In the acoustic analysis, f0 and APQ were decreased. Transient paralysis of the vocal folds secondary to recurrent and superior laryngeal nerve injury occurred in, respectively, 21% and 1.3% of the patients, decreasing to 6.6% and 0% after 6 months.


Resumo Introdução: A disfonia é um sintoma comum após a tireoidectomia. Objetivo: Analisar os sintomas vocais, auditivo-perceptivos e acústica vocal, videolaringoscopia, procedimento cirúrgico e achados histopatológicos em pacientes submetidos à tireoidectomia. Método: Estudo prospectivo. Pacientes submetidos à tireoidectomia foram avaliados da seguinte forma: anamnese, laringoscopia e avaliações vocais acústicas. Momentos: pré-operatório, 1ª avaliação pós (15 dias), 2ª avaliação pós (1 mês), 3ª avaliação pós (3 meses) e 4ª avaliação pós-operatória (6 meses). Resultados: Dos 151 pacientes, 130 eram mulheres e 21, homens. Tipos de cirurgia: lobectomia + istmectomia n = 40, tireoidectomia total n = 88, tireoidectomia + dissecção de linfonodo n = 23. Sintomas vocais foram relatados por 42 pacientes na 1ª avaliação pós-operatória (27,8%), reduzidos para 7,2% após 6 meses. Na análise acústica, f0 e APQ estavam diminuídos nas mulheres. As videolaringoscopias mostraram que 144 pacientes (95,3%) tiveram exames normais no momento pré-operatório. Paralisia das cordas vocais foi diagnosticada em 34 pacientes na 1ª avaliação pós-operatória, 32 do nervo laríngeo recorrente (lobectomia + istmectomia - n = 6; tireoidectomia total - n = 17; tireoidectomia total + dissecção de linfonodos - n = 9) e 2 do nervo laríngeo superior (lobectomia + istmectomia - n = 1; tireoidectomia total + dissecção de linfonodos - n = 1). Após 6 meses, 10 pacientes persistiram com paralisia do nervo laríngeo recorrente (6,6%). Histopatologia e correlação com paralisia das cordas vocais: bócio coloide nodular (n = 76; paralisia n = 13), tireoidite (n = 8; paralisia n = 0) e carcinoma (n = 67; paralisia n = 21). Conclusão: Os sintomas vocais, relatados por 27,8% dos pacientes na 1ª avaliação pós-operatória, diminuíram para 7% em 6 meses. Na análise acústica, f0 e APQ diminuíram. A paralisia transitória de cordas vocais secundária à lesão do nervo laríngeo recorrente e nervo laríngeo superior ocorreu, respectivamente, em 21% e 1,3% dos pacientes, reduziu-se para 6,6% e 0% após 6 meses.


Subject(s)
Humans , Male , Child , Adolescent , Adult , Middle Aged , Aged , Young Adult , Postoperative Complications/physiopathology , Postoperative Complications/epidemiology , Thyroidectomy/adverse effects , Voice Disorders/etiology , Laryngeal Diseases/etiology , Time Factors , Voice Quality/physiology , Brazil/epidemiology , Sex Factors , Vocal Cord Paralysis/etiology , Vocal Cord Paralysis/physiopathology , Vocal Cord Paralysis/epidemiology , Voice Disorders/physiopathology , Voice Disorders/epidemiology , Laryngeal Diseases/physiopathology , Laryngeal Diseases/epidemiology , Prospective Studies , Laryngeal Nerve Injuries/etiology , Laryngeal Nerve Injuries/physiopathology , Laryngeal Nerve Injuries/epidemiology , Laryngoscopy/methods , Larynx/injuries , Larynx/pathology
10.
Braz. j. otorhinolaryngol. (Impr.) ; 85(1): 63-70, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-984054

ABSTRACT

Abstract Introduction: In hypoparathyroidism, calcium supplementation using calcium carbonate is necessary for the hypocalcemia control. The best calcium carbonate intake form is unknown, be it associated with feeding, juice or in fasting. Objective: The objective was to evaluate the calcium, phosphorus and calcium × phosphorus product serum levels of hypoparathyroidism women after total thyroidectomy, following calcium carbonate intake in three different forms. Methods: A crossover study was carried out with patients presenting definitive hypoparathyroidism, assessed in different situations (fasting, with water, orange juice, breakfast with a one-week washout). Through the review of clinical data records of tertiary hospital patients from 1994 to 2010, 12 adult women (18-50 years old) were identified and diagnosed with definitive post-thyroidectomy hypoparathyroidism. The laboratory results of calcium and phosphorus serum levels dosed before and every 30 min were assessed, for 5 h, after calcium carbonate intake (elementary calcium 500 mg). Results: The maximum peak average values for calcium, phosphorus and calcium × phosphorus product were 8.63 mg/dL (water), 8.77 mg/dL (orange juice) and 8.95 mg/dL (breakfast); 4.04 mg/dL (water), 4.03 mg/dL (orange juice) and 4.12 mg/dL (breakfast); 34.3 mg2/dL2 (water), 35.8 mg2/dL2 (orange juice) and 34.5 mg2/dL2 (breakfast), respectively, and the area under the curve 2433 mg/dL min (water), 2577 mg/dL min (orange juice) and 2506 mg/dL min (breakfast), 1203 mg/dL min (water), 1052 mg/dL min (orange juice) and 1128 mg/dL min (breakfast), respectively. There was no significant difference among the three different tests (p > 0.05). Conclusion: The calcium, phosphorus and calcium × phosphorus product serum levels evolved in a similar fashion in the three calcium carbonate intake forms.


Resumo Introdução: No hipoparatireoidismo, a suplementação de cálcio com carbonato de cálcio é necessária para o controle da hipocalcemia. A melhor forma de ingestão de carbonato de cálcio ainda é desconhecida, seja concomitante com alimentação, no suco ou em jejum. Objetivo: Avaliar os níveis séricos de cálcio, fósforo e produto cálcio-fósforo em mulheres pós-tireoidectomia por hipoparatireoidismo, após a ingestão de carbonato de cálcio em três formas diferentes. Método: Foi realizado um estudo cruzado em pacientes com hipoparatireoidismo definitivo, avaliados em diferentes situações (em jejum, com água, suco de laranja, café da manhã, após washout de uma semana). A revisão dos prontuários dos pacientes de um hospital terciário de 1994 a 2010 identificou 12 mulheres adultas (18-50 anos), diagnosticadas com hipoparatireoidismo definitivo pós-tireoidectomia. Os resultados laboratoriais dos níveis séricos de cálcio e fósforo foram mensurados antes e a cada 30 minutos durante 5 horas, após a ingestão de carbonato de cálcio (cálcio elementar 500 mg). Resultados: Os valores de pico máximo médio de cálcio, fósforo e produto cálcio-fósforo foram 8,63 mg/dL (água), 8,77 mg/dL (suco de laranja) e 8,95 mg/dL (café da manhã); 4,04 mg/dL (água), 4,03 mg/dL (suco de laranja) e 4,12 mg/dL (café da manhã); 34,3 mg2/dL2 (água), 35,8 mg2/dL2 (suco de laranja) e 34,5 mg2/dL2 (café da manhã), respectivamente, e a área sob a curva foi 2.433 mg/dL.min. (água), 2.577 mg/dL.min. (suco de laranja) e 2.506 mg/dL.min. (café da manhã), 1.203 mg/dL.min. (água), 1.052 mg/dL.min. (suco de laranja) e 1.128 mg/dL.min. (café da manhã), respectivamente. Não houve diferença significante entre os três diferentes testes (p > 0,05). Conclusão: Os níveis séricos de cálcio, fósforo e produto cálcio-fósforo evoluíram de forma semelhante nas três formas de ingestão de carbonato de cálcio.


Subject(s)
Humans , Female , Adult , Middle Aged , Young Adult , Phosphorus/blood , Calcium Carbonate/administration & dosage , Calcium/blood , Dietary Supplements , Hypoparathyroidism/therapy , Phosphorus/administration & dosage , Reference Values , Thyroidectomy/adverse effects , Thyroidectomy/methods , Time Factors , Calcium Carbonate/blood , Water , Calcium/administration & dosage , Analysis of Variance , Fasting , Treatment Outcome , Cross-Over Studies , Breakfast , Fruit and Vegetable Juices
11.
In. Noya Pena, Beatriz Silvia; Illescas Caligaris, María Laura. Perioperatorio del paciente con enfermedades asociadas. Montevideo, BiblioMédica, 2019. p.53-64, ilus.
Monography in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1342502
12.
Article in Spanish | LILACS | ID: biblio-1000235

ABSTRACT

INTRODUCCIÓN: Pretendemos analizar qué factores son los que determinan la aparición de hipocalcemia en el postoperatorio de la tiroidectomía total, mediante análisis estadístico, utilizando el paquete SPSS versión 25. MATERIAL Y MÉTODO: Se han estudiado 105 pacientes intervenidos de tiroidectomía total en nuestro centro durante los años 2015 a 2017. RESULTADOS: Se trataba de 85 mujeres (81%) y 20 hombres (19%), con edades comprendidas entre 30 y 91 años, con media de 57 años. El diagnóstico anatomopatológico más frecuente fue patología benigna (82,9%), con 87 casos...


INTRODUCTION: We intend to analyze which factors are responsible for the appearance of hypocalcemia in the postoperative period of total thyroidectomy, using statistical analysis with the SPSS version 25 package. MATERIAL AND METHOD: We studied 105 patients who underwent total thyroidectomy in our center during the years 2015 to 2017. RESULTS: There were 85 women (81%) and 20 men (19%), aged between 30 and 91 years, with an average of 57 years. The most frequent anatomopathological diagnosis was benign pathology (82.9%), with 87 cases…


INTRODUÇÃO: Pretendemos analisar quais são os fatores que determinam a ocorrência de hipocalcemia na tireoidectomia total no pós-operatório, utilizando análise estatística usando SPSS versão 25. MATERIAL E MÉTODO: Foram estudados 105 pacientes que foram submetidos a tireoidectomia total em nosso centro ao longo dos anos 2015 a 2017. RESULTADOS: Foram 85 mulheres (81%) e 20 homens (19%), com idade entre 30 e 91 anos, com média de 57 anos. O diagnóstico anatomopatológico mais frequente foi a patologia benigna (82,9%), com 87 casos...


Subject(s)
Humans , Male , Adult , Thyroidectomy/adverse effects , Hypocalcemia/etiology , Postoperative Complications/epidemiology , Retrospective Studies , Hypocalcemia/prevention & control , Hypocalcemia/epidemiology
13.
Arch. endocrinol. metab. (Online) ; 61(5): 447-454, Sept.-Oct. 2017. tab
Article in English | LILACS | ID: biblio-887588

ABSTRACT

ABSTRACT Objective The aim of this study was to evaluate the use of prophylactic oral calcium after total thyroidectomy in the prevention of symptomatic hypocalcemia, and to develop a rational strategy of oral calcium supplementation following this type of surgery. Subjects and methods Prospective study including 47 patients undergoing total thyroidectomy from January 2007 to February 2012. The patients were allocated to one of the following groups: I (no postoperative calcium) or II (oral calcium 3 g per day). Oral calcium was started at the first postoperative day and administered until the sixth postoperative day. The patients were followed up for a minimum of 6 months and evaluated with a minimum of five measurements of ionized calcium: preoperative, 16 hours after surgery, seventh postoperative day, and at postoperative days 90 (PO90) and 180 (PO180). The cohort included three men and 44 women, of whom 24 (51.9%) had benign thyroid disease, and 23 had suspected or confirmed malignant disease. Results When compared with Group II, Group I had significantly higher rates of postoperative biochemical hypocalcemia at PO1 and PO180, and of symptomatic hypocalcemia at PO1, PO7, and PO90. Other data were not significantly different between the groups. Conclusion We conclude that postoperative calcium supplementation effectively prevents symptomatic and biochemical hypocalcemia after total thyroidectomy, and can be safely used after this procedure. The presented strategy of oral calcium supplementation may be implemented in a viable manner.


Subject(s)
Humans , Male , Female , Thyroidectomy/methods , Calcium/administration & dosage , Dietary Supplements , Hypocalcemia/prevention & control , Postoperative Care , Thyroid Diseases/surgery , Thyroidectomy/adverse effects , Biomarkers/blood , Administration, Oral , Prospective Studies
14.
Arch. argent. pediatr ; 115(1): e31-e33, feb. 2017.
Article in English, Spanish | LILACS | ID: biblio-838327

ABSTRACT

La insuficiencia respiratoria posoperatoria es una complicación grave de la tiroidectomia, y su origen puede ser multifactorial, especialmente en los niños. Presentamos el caso de dos hermanos sometidos a una tiroidectomia que luego tuvieron dificultad respiratoria. Para la disección de la tiroides se emplearon un bisturí armónico y el sistema de sellado vascular bipolar electrotérmico. Ambos pacientes presentaron problemas para respirar tempranamente en el posoperatorio. El hermano mayor tuvo dificultad respiratoria leve durante 24 horas, que se resolvió espontáneamente. Se extubó a la hermana menor, pero tuvo estridor grave acompañado de tiraje intercostal y retracción abdominal. Se la volvió a intubar y se la trasladó a la UCI, donde se la conectó a un respirador. Permaneció en la UCI durante 14 días debido a múltiples intentos fallidos de extubación. Es probable que los síntomas fueran más graves en la niña pequeña debido a que la pared de la tráquea era más blanda y los cartílagos, más débiles. Es necesario considerar las posibles complicaciones respiratorias posoperatorias a causa de una lesión térmica o una técnica quirúrgica inadecuada tras una tiroidectomía.


Postoperative respiratory insufficiency is a serious complication of total thyroidectomies which can be multifactorial, especially in children. We report two siblings who had undergone thyroidectomy with subsequent respiratory distress. Electrothermal bipolar and harmonic scalpel were used during thyroid dissections. Both patients had early postoperative respiratory problems. The older one suffered from mild respiratory distress for 24 hours and then he spontaneously recovered. The younger one was extubated but then she had serious stridor accompanied with abdominal and intercostal retractions. She was re-intubated and admitted to ICU for mechanical ventilatory support, where she stayed for 14 days due to multiple failed extubation attempts. The symptoms were more severe in the younger child probably due to softer tracheal wall and weaker tracheal cartilages. We should keep in mind the probable postoperative respiratory complications due to thermal injury or inappropriate surgical technique after thyroid surgeries.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Postoperative Complications/etiology , Thyroidectomy/adverse effects , Thyroidectomy/methods , Tracheal Diseases/etiology , Burns/complications , Laryngeal Diseases/etiology , Edema/etiology , Electrosurgery/adverse effects , Burns/etiology , Intraoperative Complications/etiology
15.
Rev. cuba. cir ; 55(4): 271-278, oct.-dic. 2016. tab
Article in Spanish | LILACS | ID: biblio-844826

ABSTRACT

Introducción: el tiroides es una glándula donde se asienta con frecuencia la enfermedad nodular tanto benigna como maligna. En muchas ocasiones, se presenta con criterio de intervención quirúrgica. De ella se derivan complicaciones tales como el hipoparatiroidismo posoperatorio, la lesión de los nervios laríngeos superiores, y recurrentes, así como hematoma del sitio operatorio todo lo cual nos motivó a realizar el presente trabajo. Objetivos: identificar las complicaciones derivadas de las tiroidectomías y relacionarlas con las variantes anatómicas y la extensión de la tiroidectomía. Método: se estudiaron un total de 234 intervenciones realizadas sobre el tiroides en nuestro centro desde febrero de 2012 hasta octubre de 2015. Se aplicó el método de porcientos para el cálculo de todas las variables. Se obtuvo la información existente en las historias clínicas y los informes operatorios. Resultados: la mayoría de las tiroidectomías realizadas en nuestro centro son las de afecciones benignas. Las variantes anatómicas anómalas del laríngeo recurrente se evidenciaron en algunos casos. Hubo una lesión recurrencial temporal y otra permanente para un 0,42 por ciento respectivamente. Se apreciaron tres hipoparatiroidismo temporales, con 1,28 por ciento, y una lesión vascular de arteria tiroidea media anterior anómala. Conclusiones: las afecciones benignas aún son las más frecuentes en el tiroides. El conocimiento de la anatomía del tiroides y sus variantes son vitales para realizar tiroidectomías. Las complicaciones como el hipoparatiroidismo y la lesión recurrencial se relacionan con la extensión de esta(AU)


Introduction: The thyroid gland is the frequent location of the nodular illness either benign or malignant. In many occasions, the surgical procedure is the main criterion to treat the disease. Some of the complications associated to surgery are postoperative hypoparatyroidism, upper laryngeal nerve injure, mostly outer branch; recurrent laryngeal nerve, and hematoma in the surgical site. Objectives: To identify the most frequently illnesses affecting the thyroid. Method: A total of 234 surgeries performed in the thyroid in our center from February 2012 to October 2015 were studied. The percentage method was used to estimate all the variables. Required information was taken from the medical histories and the surgery reports. Results: Most of the thyroidectomies performed in our center were on benign lesions. The anomalous anatomical variants of the recurrent laryngeal nerve were evident in some cases. There was one temporary recurrent lesion and one permanent, accounting for 0.42%, respectively. Three cases of temporary hypoparathyroidism for 1.28% and a vascular lesion in the anomalous anterior medial thyroid artery were reported. Conclusions: Benign illnesses are still the most frequent ones in the thyroid gland. The knowledge about the thyroid anatomy and its variants are vital to perform thyroidectomies. Hypoparathyroidism and recurrent laryngeal lesion are the complications related to the extension of thyroidectomy(AU)


Subject(s)
Humans , Hypoparathyroidism/complications , Thyroid Gland/injuries , Thyroidectomy/adverse effects
16.
Arch. endocrinol. metab. (Online) ; 59(5): 428-433, Oct. 2015. tab, graf
Article in English | LILACS | ID: lil-764110

ABSTRACT

ObjectiveThe aim of the present study was to identify a fast, efficient and low-cost method to diagnose hypoparathyroidism after total thyroidectomy.Materials and methodsOne hundred and forty medical records, which contained patients’ clinical and laboratory data, were retrospectively analyzed. Patient parathyroid hormone values, which were obtained immediately following operation, were compared with their ionized calcium levels the morning after surgery. This comparison was used to examine the correlation between the two variables in predicting hypoparathyroidism because measuring calcium levels is low-cost and more available in the hospitals compared to measuring parathormone (PTH) levels.ResultsThere was a positive and statistically significant correlation between PTH and ionized calcium values (Pearson correlation coefficient, r = 0.456; p < 0.0001). The values of first postoperative day ionized calcium levels (stratified by the 1.10 mmol/l cut-off value) were tested as a diagnostic measure for hypoparathyroidism, and a PTH < 15 pg/mL obtained immediately following operation served as a reference. This analysis showed that ionized calcium levels measured on the first postoperative day had a sensitivity of 45.6% (95% CI 30.9-61.0%), a specificity of 88.9% (95% CI 80.5-94.5%) and an accuracy of 76.7% (95% CI 68.7-83.5%) as a diagnostic measure for hypoparathyroidism.ConclusionIn conclusion, we demonstrated that patients who had high ionized calcium levels on the first postoperative day also had high PTH levels immediately following operation and, therefore, they had lower rates of hypoparathyroidism.


Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Calcium/blood , Hypoparathyroidism/diagnosis , Postoperative Complications/etiology , Thyroidectomy/adverse effects , Hypocalcemia/prevention & control , Hypoparathyroidism/blood , Hypoparathyroidism/etiology , Postoperative Period , Parathyroid Hormone/blood , Retrospective Studies , Sensitivity and Specificity , Time Factors
17.
Rev. chil. cir ; 67(2): 147-152, abr. 2015. tab
Article in Spanish | LILACS | ID: lil-745074

ABSTRACT

Introduction: The most frequent complication after total thyroidectomy is hypocalcemia. It is difficult to predict it. The objective of this paper is determinate if measurement of parathormone 6 hours after total thyroidectomy can predict symptomatic hypocalcemia, and determinate associated factors in the development of this complication. Material and Method: Prospective case series. Patients that underwent total thyroidectomy between 2006 and 2008 in our Hospital. We registered epidemiological data, related surgery factors and measurement of parathormone 6 hours after surgery. Hypocalcemia symptoms were registered. We used statistical analysis considering significant p < 0.05. Results: We included 82 patients. Median age was 53.2 years. 79.3 percent were female. The average of parathormone 6 hours after surgery was 28.7 pg/dL. Sensibility was 100 percent, specificity 79.4 percent, positive predictive value 59.4 percent, negative predictive value 100 percent and accuracy 84.1 percent to predict symptomatic hypocalcaemia. A statistical association among levels under the normal base line of parathormone and symptomatic hypocalcemia was detected (p < 0.0001). Relative risk was 4.84. Univariated analysis showed association between hypocalcemia and pre-operative thyroid cancer diagnosis (p = 0.01), cervical dissection (p = 0.03) and level of parathormone (p = 0.002). Multivariated analysis showed that only the level of parathormone associates with hypocalcemia (p = 0.002). Conclusion: The measurement of parathormone allows identifying which patients are at risk of presenting symptomatic hypocalcemia after total thyroidectomy.


Introducción: La complicación más frecuente de la tiroidectomía total es la hipocalcemia. Su predicción es difícil. El objetivo de este trabajo es determinar si la medición de parathormona a las 6 h posterior a una tiroidectomía total es un factor que pueda predecir la aparición de hipocalcemia sintomática y determinar los factores asociados al desarrollo de esta complicación. Material y Método: Serie de casos prospectiva. Pacientes intervenidos de tiroidectomía total entre 2006 y 2008 en el Hospital FACH. Se registraron datos epidemiológicos, factores relacionados a la cirugía y la medición de parathormona a las 6 h. Se registraron los síntomas de hipocalcemia. Se utilizó estadística analítica considerando significativo p < 0,05. Resultados: Se enrolaron 82 pacientes. La edad media fue 53,2 años. El 79,3 por ciento fue de sexo femenino. El promedio de parathormona a las 6 h fue 28,7 pg/dL. Se obtuvo sensibilidad 100 por ciento, especificidad 79,4 por ciento, valor predictivo positivo 59,4 por ciento, negativo 100 por ciento y precisión 84,1 por ciento para predecir hipocalcemia. Cuando los valores de PTH estaban bajo el margen normal, el riesgo relativo de hipocalcemia sintomática fue 4,84 (p < 0,0001). El análisis univariado mostró asociación entre hipocalcemia y el diagnóstico pre operatorio de cáncer (p = 0,01), la disección cervical (p = 0,03) y el nivel de parathormona a las 6 h (p = 0,002). El análisis multivariado demostró que sólo el nivel de parathormona se asocia con hipocalcemia (p = 0,002). Conclusión: La medición de parathormona es un elemento que permite estimar de manera adecuada qué pacientes están en riesgo de presentar hipocalcemia sintomática en el post-operatorio precoz de tiroidectomía total.


Subject(s)
Humans , Male , Adolescent , Adult , Female , Young Adult , Middle Aged , Aged, 80 and over , Hypocalcemia/diagnosis , Hypocalcemia/blood , Parathyroid Hormone/analysis , Thyroidectomy/adverse effects , Analysis of Variance , Follow-Up Studies , Hypocalcemia/etiology , Parathyroid Hormone/blood , Postoperative Complications , Predictive Value of Tests , Prospective Studies , Sensitivity and Specificity , Time Factors
18.
Rev. chil. cir ; 67(2): 199-203, abr. 2015. ilus
Article in Spanish | LILACS | ID: lil-745083

ABSTRACT

Introduction: Thyroid surgery rates have tripled over the past 3 decades. Currently, the main postoperative complications of this surgery are vocal fold paralysis because of recurrent laryngeal nerve dysfunction and hypocalcemia. Case report: We report the case of a 58 years old woman who presented with persistent dysphonia post total thyroidectomy. Laryngeal videostroboscopy evidenced unilateral vocal fold paralysis. We performed a percutaneous injection laryngoplasty with hyaluronic acid achieving significant improvement in voice. Conclusions: Percutaneous injection laryngoplasty with hyaluronic acid is a safe and effective procedure in the management of post thyroidectomy vocal cord paralysis.


Introducción: La tasa de cirugía tiroidea se ha triplicado en las últimas 3 décadas. Dentro de sus complicaciones se encuentra la parálisis de cuerda vocal unilateral secundaria a lesión transitoria o permanente del nervio laríngeo recurrente, lo que se presenta clínicamente como disfonía. Caso clínico: Paciente de 58 años, post tiroidectomía total evoluciona con disfonía persistente. Videoestroboscopia evidencia parálisis cuerda vocal izquierda en posición paramediana, con hiato fonatorio longitudinal amplio. Se maneja con laringoplastía por inyección con ácido hialurónico a cuerda vocal paralítica, logrando mejora significativa de voz. En videoestroboscopia de control al 7º día se evidencia cuerda vocal izquierda en línea media, con borde libre recto, sin presencia de hiato al fonar. Conclusiones: La laringoplastía por inyección percutánea con ácido hialurónico es un procedimiento seguro y eficaz para el tratamiento de la disfonía secundaria a parálisis cordal unilateral post cirugía tiroidea.


Subject(s)
Humans , Female , Middle Aged , Hyaluronic Acid/administration & dosage , Laryngoscopy/methods , Vocal Cord Paralysis/surgery , Vocal Cord Paralysis/etiology , Thyroidectomy/adverse effects , Dysphonia/surgery , Dysphonia/etiology , Injections
19.
Yonsei Medical Journal ; : 1389-1394, 2015.
Article in English | WPRIM | ID: wpr-39978

ABSTRACT

PURPOSE: To report clinical characteristics of thyroid-associated ophthalmopathy (TAO) in patients who previously underwent total thyroidectomy for thyroid cancer or a benign mass of the thyroid. MATERIALS AND METHODS: Of the patients who were diagnosed with TAO from March 2008 to March 2012, we performed a retrospective chart review on those who had undergone total thyroidectomy for thyroid cancer or a benign mass of the thyroid before the occurrence of ophthalmopathy. RESULTS: Of the 206 patients diagnosed with TAO, seven (3.4%) met the inclusion criteria. The mean age of the subjects was 47.4 years, and all were female. Six patients were diagnosed with papillary thyroid cancer, and one was diagnosed with a benign mass. The duration between total thyroidectomy and onset of TAO ranged from 3-120 months (median 48 months). Ophthalmic manifestations varied among cases. Except for the patient who was diagnosed with a benign mass, all patients showed hyperthyroid status and were under Synthroid hormone treatment at the time of TAO development. Five of these six patients had positive levels of thyroid-stimulating hormone (TSH) receptor autoantibodies. CONCLUSION: TAO rarely develops after total thyroidectomy, and the mechanism of TAO occurrence is unclear. However, most patients showed abnormalities in thyroid function and TSH receptor autoantibodies.


Subject(s)
Adult , Aged , Autoantibodies/blood , Carcinoma , Carcinoma, Papillary/immunology , Female , Graves Ophthalmopathy/diagnosis , Humans , Male , Middle Aged , Postoperative Complications/etiology , Receptors, Thyrotropin , Retrospective Studies , Thyroid Neoplasms/complications , Thyroidectomy/adverse effects , Thyrotropin/blood , Treatment Outcome
20.
Yonsei Medical Journal ; : 637-642, 2013.
Article in English | WPRIM | ID: wpr-193940

ABSTRACT

PURPOSE: Hypocalcemia is the most common complication after total thyroidectomy. The purpose of this study was to determine whether measurement of intact parathyroid hormone (i-PTH) level in thyroidectomy patients could predict hypocalcemia. MATERIALS AND METHODS: We performed a prospective study of patients undergoing total thyroidectomy. Serum concentration of i-PTH, total calcium (Ca), ionized calcium (Ca2+), phosphate (P), magnesium (Mg), and albumin were measured preoperatively and at 0 hour, 6 hours, 12 hours, 24 hours, 48 hours, and 72 hours postoperatively. RESULTS: 108 patients were recruited to the study. A total of 50 patients (46%) experienced hypocalcemia. The serum i-PTH concentration was linearly related to the time of measurement, while concentrations of P, Mg, albumin, Ca, and Ca2+ were not. We compared odds ratios, and found that the concentration of i-PTH at 6 hours post operation was the most closely related to the occurrence of hypocalcemic symptom. On ROC analysis using i-PTH level at 6 hours, an i-PTH level of 10.6 mg/dL was found to maximize both sensitivity and specificity at the same time point. CONCLUSION: We found that i-PTH was a predictor of hypocalcemia, and that the earliest predictor of hypocalcemic symptoms was an i-PTH concentration lower than 10.6 mg/dL obtained 6 hours after total thyroidectomy.


Subject(s)
Calcium/blood , Humans , Hypocalcemia/diagnosis , Magnesium/blood , Odds Ratio , Parathyroid Hormone/blood , Phosphates/blood , Postoperative Complications/blood , Prospective Studies , Serum Albumin , Thyroidectomy/adverse effects
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