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KMID : 0986520150150030060
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Korean Journal of Endoscrine Surgery
2015 Volume.15 No. 3 p.60 ~ p.66
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Factors Predicting Hypocalcemia after Total Thyroidectomy with Central Lymph Node Dissection in Papillary Thyroid Cancer
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Lee Ok-Joo
Kim Hyung-Chul
Lim Chul-Wan
Shin Eung-Jin
Cho Gyu-Seok
Chung Jun-Chul
Jeong Gu-Ae
Kim Zi-Sun
Jeong Jae-Hong
Choi Kyu-Sung
Han Sun-Wook
Hur Sung-Mo
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Abstract
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Purpose: Total thyroidectomy with central lymph node dissection (CLND) is a treatment modality of choice for thyroid cancer. Hypocalcemia is the most common complication after total thyroidectomy. The aim of the current study was to determine the association between surgery-related clinical factors and postoperative hypocalcemia.
Methods: A prospective analysis was performed for 101 patients who underwent total thyroidectomy with CLND for papillary cancer from June 2013 to June 2014. Correlation between clinicopathologic factors and postoperative hypocalcemia was analyzed.
Results: Based on the postoperative day-2 calcium, 56 patients (55%) developed hypocalcemia and 45 patients (45%) were normal. No significant differences in histopathologic (tumor size, tumor focality, histologic type, number of retrieved lymph nodes, metastatic lymph node, thyroiditis, retrieved parathyroid gland) findings were observed between the hypocalcemia group and normal calcium group. Mean value of the postoperative day-0 parathyroid hormone (PTH) was significantly lower in the hypocalcemia group (hypoca1cemia group: 14.3±9.4 pg/mL; normal group: 25.0±16.4 pg/mL; P＜0.001). In logistic regression analysis, postoperative PTH was a factor significantly affecting postoperative hypocalcemia (OR 0.93; CI: 0.90-0.97; P＜0.001). In ROC analysis, the cut-off value of PTH was 19.965 (sensitivity 79%, specificity 58%), and area under the curve (AUC) was 0.709 (95% CI: 0.607-0.811).
Conclusion: Postoperative PTH was a factor predicting hypocalcemia after total thyroidectomy with CLND. Use of postoperative PTH as a screening tool for prediction of postoperative hypocalcemia would be useful in management of patients with hypocalcemia.
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KEYWORD
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Thyroid cancer, Total thyroidectomy, Hypocalcemia, Parathyroid hormone
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