Procjena rizika od hipokalcemije nakon totalne tireoidektomije

master's thesis

• Title (english): Identifying the most reliable predictor of hypocalcemia after total thyroidectomy
• Author: Ana Gašić
• Mentor: Andro Košec (mentor)
• Committee member: Ivan Rašić (predsjednik povjerenstva)
• Committee member: Mihael Ries (član povjerenstva)
• Committee member: Andro Košec (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Othorhinolaryngology and Head and Neck Surgery); Zagreb
• Defense date and country: 2021-07-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Otorhinolaryngology

Abstract

UVOD: Totalna tireoidektomija (TT) jedan je od najčešće izvođenih zahvata u kirurgiji glave i vrata. Istraživanja pokazuju da je totalna tireoidektomija siguran zahvat u liječenju malignih i dijela benignih bolesti štitnjače. Najčešće postoperativne komplikacije su hipokalcemija i ozljeda povratnog laringealnog živca. U praćenju postoperativne hipokalcemije koriste se koncentracije PTH-a te serumskog i ioniziranog kalcija. ----- MATERIJALI I METODE: U studiju je bilo uključeno 205 bolesnika podvrgnutih totalnoj tireoidektomiji. Svim pacijentima su preoprativno određene razine kalcija u krvi te su isključeni bolesnici s patološkim koncentracijama, kao i oni s nepotpunom dokumentacijom. Nakon provedene totalne tireoidektomije određivane su razine PTH-a, serumskog i ioniziranog kalcija sat vremena nakon operacije i prvog postoperativnog dana. Temeljem nalaza dijagnostičkih testova, napravljena je statistička analiza parametara u svrhu pronalaska najtočnijeg prediktora razvoja simptomatske hipokalcemije. Također je ispitivana potreba korištenja Peyneove korekcijske formule za serumski kalcij. ----- REZULTATI: PTH određen prvi postoperativni dan je najosjetljiviji parametar za predikciju razvoja simptomatske hipokalcemije (80,22% pri graničnoj vrijednosti ≤2,03 pmol/L), a učinkovit su i ionizirani i serumski kalcij određeni prvi postoperativni dan (osjetljivost 80% pri graničnoj vrijednosti od 1,15 mmol/L, odnosno 79,07% pri graničnoj vrijednosti od ≤2,02 mmol/L. Korištenje Peyneove korekcijske formule nije se pokazalo učinkovitim. ----- ZAKLJUČAK: U slučaju potrebe predikcije razvoja simptomatske hipokalcemije nakon totalne tireoidektomije opravdano je koristiti razine PTH-a i serumskog kalcija određene prvi postoperativni dan, bez potrebe korištenja korekcijske formule sza serumski kalcij.

Abstract (english)

INTRODUCTION: Total thyroidectomy (TT) is one of the most commonly performed procedures in head and neck surgery. Studies show that total thyroidectomy is a safe procedure in the treatment of malignant and some benign thyroid diseases. The most common postoperative complications are hypocalcemia and recurrent laryngeal nerve injury. Concentrations of PTH and serum and ionized calcium are used to monitor postoperative hypocalcemia. ----- MATERIALS AND METHODS: The study included 205 patients who underwent total thyroidectomy. All patients had preoperative blood calcium levels and patients with pathological concentrations, as well as those with incomplete documentation, were excluded. After total thyroidectomy, levels of PTH, serum, and ionized calcium were determined one hour after surgery and on the first postoperative day. Based on the findings of diagnostic tests, a statistical analysis of parameters was performed to find the most accurate predictor of the development of symptomatic hypocalcemia. The necessity of Payne correction formula for serum calcium was also examined. ----- RESULTS: PTH determined on the first postoperative day is the most sensitive parameter for the prediction of symptomatic hypocalcemia development (80.22% at the cut-off value ≤2.03 pmol/L). Ionized and serum calcium determined on the first postoperative day are also effective (sensitivity 80% at the cut-off value of 1.15 mmol/L, and 79.07% at the cut-off value of ≤2.02 mmol/L, respectively). The use of Payne’s correction formula is not effective. ----- CONCLUSION: The development of symptomatic hypocalcemia after total thyroidectomy can be predicted with PTH and serum calcium levels determined on the first postoperative day, without using correction formula for serum calcium.

• Keywords: kalcij; hipokalcemija; paratireoidni hormon; totalna tireoidektomija
• Keywords (english): calcium; hypocalcemia; parathyroid hormone; total thyroidectomy
• Language: croatian
• URN:NBN: urn:nbn:hr:105:694483
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-02-03 10:56:41