Selim Yiğit YILDIZ, MEHMET ÖZYILDIZ, Özkan SUBAŞI, Sadettin ER, HAMDİ TANER TURGUT, Murat COŞKUN, Adem YÜKSEL

Tiroidektomi Sonrası Hipokalsemi Gelişiminde Paratiroid Hormon ve Diğer Faktörlerin Etkisi

GİRİŞ ve AMAÇ: Bu çalışmada farklı tiroidektomi teknikleri uygulanan hastalarda teknik, hormonal ve beze ait faktörleri inceleyerek hipokalsemiye etki eden nedenleri ortaya koymak amaçlanmıştır. GEREÇ ve YÖNTEM: Prospektif olarak yapılmış bu çalışmaya benign ve malign tiroid hastalıkları nedeniyle tiroidektomi yapılan 145 hasta dahil edilmiştir. Hastalar cerrahi yönteme göre üç gruba ayrılarak demografik özellikler, hastalık ve cerrahi esnasındaki özellikleri, postoperatif komplikasyonlar ve serum parathormon (PTH) düzeyleri karşılaştırılarak istatistiksel olarak analiz edilmiştir. BULGULAR: Hastaların 118'i kadın 27'si erkek, yaş ortalaması 45.03±13.5'dir. 145 hastanın 34 (%23) tanesinde komplikasyon gelişmiştir. Geçici hipokalsemi en sık görülen komplikasyon olup 22 (%15) hastada meydana gelmiştir. Komplikasyon gelişme oranları açısından gruplar arasında anlamlı fark saptanmamıştır (p>0.05) ancak Grup 3 (Bilateral total tiroidektomi)' te komplikasyon oranları daha yüksektir. Hipokalsemi gelişen hastalarda erken ve geç PTH değerleri anlamlı olarak düşük seyretmektedir (p

The Effect of Parathyroid Hormone and Other Factors on PostThyroidectomy Hypocalcemia Development

INTRODUCTION: In this study, to evaluate the technical, hormonal, and gland factors in patients in whom different thyroidectomy techniques have been applied and it is aimed to find out the reasons which cause hypocalcemia. METHODS: In a study which was conducted prospectively, 145 patients had been included that those patients had undergone surgery because of their benign or malignant thyroidal illnesses. According to the surgical method applied, the patients were categorized into three groups and their demographic information, the characteristics observed during their illness and operation, the postoperative findings, and serum parathormon (PTH) levels were analyzed from a statistical perspective. RESULTS: Study cohort was consist of 118 female and 27 male patients . The average age of the patients were 45.03±13.5 years. A complication developed in the 34 of the 145 patients (23%). Temporary hypocalcemia was observed to be the most common complication which was seen in 22 (15%) patients. No meaningful difference among groups form the perspective of complication development rate had been found (p?0,05) ; however, in group 3 (bilateral total thyroidectomy) the complication rates were higher. Patients in whom hypocalcemia developed, the early and late PTH values were significantly low (p ?0,001). In multivariate analysis, the fact that the preoperative thyrotoxicosis, nerve dissection and preoperative PTH is near the upper limit, are effctive factors from statistical point of view (p<0.05) DISCUSSION AND CONCLUSIONS: The factors which are effective in the development of hypocalcemia after thyroidectomy are: bilateral total thyroidectomy, the application of inoperatve nerve dissection, preoperative toxic goitre diagnosis, and that the preoperative PTH is near the upper limit. The levels of hypocalcemia can be reduced with the help of convenient preoperative preparation and correct surgical technique.

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