Risikofaktoren für den permanenten postoperativen Hypoparathyreoidismus

Abstract

Zusammenfassung Hintergrund Der permanente postoperative Hypoparathyreoidismus ist die häufigste Komplikation nach einer totalen Thyreoidektomie mit erheblichen möglichen Folgeerkrankungen, Beeinträchtigung der Lebensqualität und hoher sozioökonomischer Bedeutung. Zielsetzung Identifikation von Risikofaktoren für den permanenten postoperativen Hypoparathyreoidismus. Material und Methoden 420 Patienten unseres Schilddrüsenzentrums erhielten zwischen 08/2012 und 08/2014 eine totale Thyreoidektomie. 382 gingen in die Studie ein. An einer Follow-up-Untersuchung zwischen 8 und 32 Monaten nach der Operation nahmen 117 teil. Ergebnisse Mit einem permanenten postoperativen Hypoparathyreoidismus waren assoziiert: erniedrigter PTH-Wert am 1. postoperativen Tag, Verzicht bzw. Nichterfordernis einer Redon-Drainage und eine lange Krankenhausverweildauer. Die Assoziationen waren ausgeprägt, jedoch nicht signifikant. Diskussion Wir ermittelten Hinweise auf Prädiktoren für den permanenten postoperativen Hypoparathyreoidismus. Eine Validierung als relevante Risikofaktoren sollte in größeren Multicenterstudien erfolgen. Die Kenntnis von Risikofaktoren könnte zur Vermeidung dieser Komplikation und zur gezielten Nachsorgebetreuung gefährdeter Patienten dienen.

How Long Does It Take to Regain Normocalcaemia in the Event of Postsurgical Hypoparathyroidism? A Detailed Time Course Analysis

“…Historically, the duration of PH is termed and classified taking account of two different intervals: transient PH, i.e., PH lasting for less than 12 or less than 24 weeks, and permanent PH for cases lasting longer than either 6 or 12 months. This is also found in most clinical guidelines [ 1 , 5 , 6 , 7 , 8 , 9 , 10 , 13 , 17 , 18 ]. Hence, predictors of the duration of PH were determined using logistic regression analysis at these specific time points: 12, 24, and more than 24 weeks after surgery.…”

“…Historically and currently presented in the respective guidelines, PH is termed transient whenever full recovery occurs either within 12 or within 24 weeks, and it is considered persistent if a biochemical recovery is not documented at 24 weeks [ 1 , 5 , 6 , 7 , 8 , 9 , 10 , 17 ] or after a period of 12 months [ 13 , 18 ]. In order to interpret potential predictors for the duration or recovery of PH, these intervals were, therefore, taken into account.…”

“…Bilezikian et al reported rates for PH at 24 weeks ranging between 0.9% and 1.6% in centres with a record of excellence in endocrine surgery and suggested the 6-month time period to be sufficient to ascertain permanent postoperative hypoparathyroidism [ 6 ]. Others have published rates of permanent PH ranging from 0.5% to 8.6% [ 1 , 2 , 10 , 11 , 13 ] and rates of recovery ranging from 6.9% to 46%, again using a broad range of definitions [ 6 , 17 ]. However, besides such “endpoint-observations” at either 6 or 12 months, the current literature does not offer any insight into the actual time course of recovery from PH.…”

“…Hence, predictors of the duration of PH were determined using logistic regression analysis at these specific time points: 12, 24, and more than 24 weeks after surgery. In accordance with current guidelines, all cases with clinical signs of hypocalcaemia or need for calcium and active vitamin D (i.e., Calcitirol; 1,25 (OH)2D3) medication or biochemically proven hypocalcaemia and/or hypoprothrombinaemia persisting for more than twelve months after surgery were defined to have “permanent hypoparathyroidism” [ 1 , 5 , 6 , 7 , 8 , 9 , 10 , 13 , 17 , 18 ].…”