甲状腺全切术后甲状旁腺功能减退的恢复时间分析(附13例)

Recovery time analysis of hypoparathyroidism after total thyroidectomy(13 cases)

目的:浅析甲状腺癌甲状腺全切术后甲状旁腺功能减退患者的恢复时长及其分布。方法:对我科2013年至2019年470例甲状腺癌甲状腺全切患者的病历资料进行了回顾,将其中有完整记录术前术后甲状旁腺激素(parathyroid hormone,PTH)水平的电子病历资料进行了随访分析。筛选出13例术后甲状旁腺功能先减低再恢复的病例。通过13例患者甲状旁腺激素从减低到恢复到正常低限的时长,分析甲状腺全切术后甲状旁腺功能恢复的时间分布。结果:术后发生甲状旁腺功能减退的患者在1月内恢复的占30.8%(4/13),2至3月内恢复的占30.8%(4/13),4至6月内恢复的占7.7%(1/13),超过6月恢复的占30.8%(4/13)。暂时性甲状旁腺功能减退的患者大部分于4月内甲状旁腺激素水平恢复正常,部分(30.8%)永久性(超过6个月)甲状旁腺功能减退的患者甲状旁腺激素水平可以恢复正常。结论:甲状腺全切术后暂时性甲状旁腺功能减退的患者,甲状旁腺激素水平恢复正常的时长主要分布在2至6月,即使超过6个月,通常被认为是永久性甲状旁腺功能减退的患者,仍有约1/3甲状旁腺功能恢复正常。并非所有永久性甲状旁腺功能减退的患者是真正的永久性甲状旁腺功能减退。

Objective:To analyse the recovery time and distribution of hypoparathyroidism in patients with thyroid carcinoma after total thyroidectomy.Methods:The medical records of 470 patients with total thyroidectomy of thyroid cancer in our department from 2013 to 2019 were reviewed,and the electronic medical records with complete preoperative and postoperative parathyroid hormone(PTH)levels were followed up and analyzed in 13 patients.Thirteen cases with reduced parathyroid function after operation were screened out.The recovery time of hypoparathyroidism after total thyroidectomy was analyzed by the duration of parathyroid hormone reduction to normal low limit.And the distribution of recovery time was analyzed by follow-up.Results:Patients with postoperative hypoparathyroidism recovered within 1 month 30.8%(4/13),30.8%(4/13)within 2 to 3 months,7.7%(1/13)within 4 to 6 months,and 30.8%(4/13)beyond 6 months.The majority of patients with temporary hypoparathyroidism had normal parathyroid hormone levels within 4 months,while parathyroid hormone levels in some patients(30.8%)with permanent hypoparathyroidism(over 6 months)returned to normal.Conclusion:In patients with temporary parathyroid dysfunction after total thyroidectomy,the time for the return of parathyroid hormone level to normal is mainly distributed from 2 to 6 months.Even after 6 months,about 1/3 of patients with parathyroid dysfunction,which is generally considered permanent,still return to normal.Not all patients with permanent hypoparathyroidism are truly permanent hypoparathyroidism.