Clinical Significance of Intact Parathyroid Hormone Detection in Postoperative Serum and Surgical Drainage after Total Thyroid Resection_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 YAOJing ¹ ,  TIANWen ²

1. Department of General Surgery, The First Affiliated Hospital, General Hospital of PLA, Beijing 100048, China;
2. Department of General Surgery, General Hospital of PLA, Beijing 100039, China;

Corresponding author：

TIANWen, Email: tianwen301@sina.com

Keywords：

Thyroid cancer; Total thyroidectomy; Intact parathyroid hormone

DOI：

10.7507/1007-9424.20140336

Video：

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Objective To discuss the clinical significance of intact parathyroid hormone (iPTH) detection of postoperative serum and surgical drainage in predicting parathyroid function. Methods The clinical data of 50 patients with thyroid cancer performed total thyroidectomy from January 2013 to July 2013 in the PLA General Hospital and the First Affiliated Hospital of PLA General Hospital were analyzed retrospectively.In this cohort, there were 49 pappillary carcinomas and 1 medullary carcinoma.All the patients received total thyroidectomy andⅥlymph nodes dissection, and 18 of these patients received neck lymph nodes dissection additionally.The negative pressure drainage was placed in the operated area, and the drained fluid and blood were tested for iPTH level on the first day and the third day postoperatively. Results The preoperative iPTH levels were within the normal range for all the patients.The postoperative serum iPTH level was (12.85±10.50) ng/L (4.64-13.15 ng/L) and (17.45±11.33) ng/L (7.33-26.50 ng/L) on the first day and the third day, respectively, there was no significant difference of the postoperative serum iPTH levels between the first day and the third day (P=0.293).The postoperative surgical drainage iPTH level was (1 550.29±1 678.18) ng/L (5 000-112 ng/L) and (566.73±753.99) ng/L (2 065-2.81 ng/L) on the first day and the third day, respectively, there was no significant difference of surgical drainage iPTH between the first day and the third day too (P=0.060). Conclusions By detecting the postoperative surgical drainage iPTH level combined with serum iPTH level, it could better predict the function of parathyroid after total thyroidectomy, and correctly assess the prognosis of patients.

Citation： YAOJing, TIANWen. Clinical Significance of Intact Parathyroid Hormone Detection in Postoperative Serum and Surgical Drainage after Total Thyroid Resection. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(11): 1413-1416. doi: 10.7507/1007-9424.20140336 Copy

1.	田文, 姚京.原发性甲状旁腺功能亢进的外科治疗及评价[J].中国实用外科杂志, 2014, 34(4):303-305.
2.	Yano Y, Masaki C, Sugino K, et al.Serum intact parathyroid hormone level after total thyroidectomy or total thyroidectomy plus lymph node dissection for thyroid nodules:report from 296 surgical cases[J].Int J Endocrinol Metab, 2012, 10(4):594-598.
3.	Kim JP, Park JJ, Son HY, et al.Effectiveness of an i-PTH measurement in predicting post thyroidectomy hypocalcemia:prospective controlled study[J].Yonsei Med J, 2013, 54(3):637-642.
4.	Kim JH, Chung MK, Son YI.Reliable early prediction for different types of post-thyroidectomy hypocalcemia[J].Clin Exp Otorhinolaryngol, 2011, 4(2):95-100.
5.	Wilson RB, Erskine C, Crowe PJ.Hypomagnesemia and hypocalcemia after thyroidectomy:prospective study[J].World J Surg, 2000, 24(6):722-726.
6.	Bergenfelz A, Jansson S, Kristoffersson A, et al.Complications to thyroid surgery:results as reported in a database from a multicenter audit comprising 3660 patients[J].Langenbecks Arch Surg, 2008, 393(5):667-673.
7.	Glinoer D, Andry G, Chantrain G, et al.Clinical aspects of early and late hypocalcaemia after thyroid surgery[J].Eur J Surg Oncol, 2000, 26(6):571-577.
8.	Khairy GA, Al-Saif A.Incidental parathyroidectomy during thyroid resection:incidence, risk factors, and outcome[J].Ann Saudi Med, 2011, 31(3):274-278.
9.	Del Rio P, Arcuri MF, Ferreri G, et al.The utility of serum PTH assessment 24 hours after total thyroidectomy[J].Otolaryngol Head Neck Surg, 2005, 132(4):584-586.
10.	中华医学会内分泌学分会, 中华医学会外科学分会, 中国抗癌协会头颈肿瘤专业委员会, 等.甲状腺结节和分化型甲状腺癌诊治指南[J].中国肿瘤临床, 2012, 39(17):1249-1272.
11.	Modarai B, Sawyer A, Eills H.The glands of Owen[J].J R Soc Med, 2004, 97(10):494-495.
12.	Lee DY, Cha W, Jeong WJ, et al.Preservation of the inferior thyroidal vein reduces post-thyroidectomy hypocalcemia[J].Laryngoscope, 2014, 124(5):1272-1277.
13.	Bliss RD, Gauger PG, Delbridge LW.Surgeon's approach to the thyroid gland:surgical anatomy and the importance of technique[J].World J Surg, 2000, 24(8):891-897.
14.	陈杨, 李文杰, 林乐岷.被膜解剖技术用于甲状腺全切除术[J].中国临床医学, 2011, 18(5):708-710.
15.	周广起, 刘新梅, 熊斌, 等.分化型甲状腺癌术后PTH变化及发生低钙血症的临床分析[J].中国普通外科杂志, 2014, 23(5):700-702.
16.	Julián MT, Balibrea JM, Granada ML, et al.Intact parathyroid hormone measurement at 24 hours after thyroid surgery as predictor of parathyroid function at long term[J].Am J Surg, 2013, 206(5):783-789.
17.	Graciano AJ, Chone CT, Fischer CA.Applicability of immediate, late or serial intact parathyroid hormone measurement following total thyroidectomy[J].Braz J Otorhinolaryngol, 2012, 78(5):78-82.
18.	Pisanu A, Saba A, Coghe F, et al.Early prediction of hypocalcemia following total thyroidectomy using combined intact parathyroid hormone and serum calcium measurement[J].Langenbecks Arch Surg, 2013, 398(3):423-430.
19.	Costanzo M, Marziani A, Condorelli F, et al.Post-thyroidectomy hypocalcemic syndrome:predictive value of early PTH.Preliminary results[J].Ann Ital Chir, 2010, 81(4):301-305.

1. 田文, 姚京.原发性甲状旁腺功能亢进的外科治疗及评价[J].中国实用外科杂志, 2014, 34(4):303-305.
2. Yano Y, Masaki C, Sugino K, et al.Serum intact parathyroid hormone level after total thyroidectomy or total thyroidectomy plus lymph node dissection for thyroid nodules:report from 296 surgical cases[J].Int J Endocrinol Metab, 2012, 10(4):594-598.
3. Kim JP, Park JJ, Son HY, et al.Effectiveness of an i-PTH measurement in predicting post thyroidectomy hypocalcemia:prospective controlled study[J].Yonsei Med J, 2013, 54(3):637-642.
4. Kim JH, Chung MK, Son YI.Reliable early prediction for different types of post-thyroidectomy hypocalcemia[J].Clin Exp Otorhinolaryngol, 2011, 4(2):95-100.
5. Wilson RB, Erskine C, Crowe PJ.Hypomagnesemia and hypocalcemia after thyroidectomy:prospective study[J].World J Surg, 2000, 24(6):722-726.
6. Bergenfelz A, Jansson S, Kristoffersson A, et al.Complications to thyroid surgery:results as reported in a database from a multicenter audit comprising 3660 patients[J].Langenbecks Arch Surg, 2008, 393(5):667-673.
7. Glinoer D, Andry G, Chantrain G, et al.Clinical aspects of early and late hypocalcaemia after thyroid surgery[J].Eur J Surg Oncol, 2000, 26(6):571-577.
8. Khairy GA, Al-Saif A.Incidental parathyroidectomy during thyroid resection:incidence, risk factors, and outcome[J].Ann Saudi Med, 2011, 31(3):274-278.
9. Del Rio P, Arcuri MF, Ferreri G, et al.The utility of serum PTH assessment 24 hours after total thyroidectomy[J].Otolaryngol Head Neck Surg, 2005, 132(4):584-586.
10. 中华医学会内分泌学分会, 中华医学会外科学分会, 中国抗癌协会头颈肿瘤专业委员会, 等.甲状腺结节和分化型甲状腺癌诊治指南[J].中国肿瘤临床, 2012, 39(17):1249-1272.
11. Modarai B, Sawyer A, Eills H.The glands of Owen[J].J R Soc Med, 2004, 97(10):494-495.
12. Lee DY, Cha W, Jeong WJ, et al.Preservation of the inferior thyroidal vein reduces post-thyroidectomy hypocalcemia[J].Laryngoscope, 2014, 124(5):1272-1277.
13. Bliss RD, Gauger PG, Delbridge LW.Surgeon's approach to the thyroid gland:surgical anatomy and the importance of technique[J].World J Surg, 2000, 24(8):891-897.
14. 陈杨, 李文杰, 林乐岷.被膜解剖技术用于甲状腺全切除术[J].中国临床医学, 2011, 18(5):708-710.
15. 周广起, 刘新梅, 熊斌, 等.分化型甲状腺癌术后PTH变化及发生低钙血症的临床分析[J].中国普通外科杂志, 2014, 23(5):700-702.
16. Julián MT, Balibrea JM, Granada ML, et al.Intact parathyroid hormone measurement at 24 hours after thyroid surgery as predictor of parathyroid function at long term[J].Am J Surg, 2013, 206(5):783-789.
17. Graciano AJ, Chone CT, Fischer CA.Applicability of immediate, late or serial intact parathyroid hormone measurement following total thyroidectomy[J].Braz J Otorhinolaryngol, 2012, 78(5):78-82.
18. Pisanu A, Saba A, Coghe F, et al.Early prediction of hypocalcemia following total thyroidectomy using combined intact parathyroid hormone and serum calcium measurement[J].Langenbecks Arch Surg, 2013, 398(3):423-430.
19. Costanzo M, Marziani A, Condorelli F, et al.Post-thyroidectomy hypocalcemic syndrome:predictive value of early PTH.Preliminary results[J].Ann Ital Chir, 2010, 81(4):301-305.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Significance of Intact Parathyroid Hormone Detection in Postoperative Serum and Surgical Drainage after Total Thyroid Resection

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