Uticaj hirurške traume na koncentraciju paratiroidnog hormona i kalcijuma u pacijenata podvrgnutih totalnoj tiroidektomiji kod benignih oboljenja štitaste žlezde
The aim of this work is the determination of the most
important clinicaly, pathological and biochemical risk factors for
postoperative clinically relevant hypocalcemia.
This clinical study is prospective and controlled. The study
included one hundred patients at the Departement of General
Surgery, Clinical Center of Nis, who underwent a total thyroidectomy
for benign thyroid disease in general endotracheal anesthesia.
The study assessed the intraoperative and postoperative PTH,
calcium and phosphorus in patients who underwent a total
thyroidectomy. It was performed risk assessments for the occurrence
of postoperative hypocalcemia therapy and prognosis for these
patients.
The results showed that there are significant biochemical and
clinical parameters that influence the occurrence of postoperative
hypocalcemia. Characteristics associated with a hypocalcemia were:
preoperatively measured values of calcium, vitamin D and calcitonin,
PTH and weight gland.
Reduction in PTH by 1% increases the risk of intraoperative
hypocalcemia 4.9%. Increasing calcium levels preoperatively to 1
mmol/L reduces the risk of intraoperative hypocalcemia by 100%,
while any increase in the value of preoperative vitamin D reduces the
risk of intraoperative hypocalcemia by 11.9%
Increased preoperative calcitonin measured level of 1 pg/ml
reduces the risk of hypocalcemia 12 hours after surgery by 66.1%,
increasing the level of preoperative calcitonin for 1 pg/ml reduce the
risk of hypocalcemia registered 24 hours after surgery by 97%,
whereas any increase in weight removed the thyroid gland to 1g
increase the risk of intraoperative hypocalcemia by 9,8%.
Calcium levels postoperatively reached the lowest level after
12 hours (total of 78 patients have lowered calcium), and then begins
to rise, and the number of patients with reduced calcium begins to
decrease.
Surgical trauma has increased the number of patients with
hypocalcemia. There were a maximum of 64% 12 hours after total
thyroidectomy. After that, the presence of hypocalcemia among
respondents reduced and calcium normalizes within two months
postoperatively