The Damnification And Protection Of Parathyroid Function After Total Thyroidectomy

Objective: To investigate the safety of total thyroidectomy and the intraoperative andpostoperative protection method for parathyroid.Methods: Select randomly75inpatients diagnosed as nodular goiter or thyroid cancer,inthe same surgery group of First Hospital of Jilin University from April,2012to October,2012.These inpatients were seperated randomly into two groups:control group(A gruoup)29cases and test group (B group)56cases.Both groups accepted gluconate4g/d from onset ofsurgery day,and in addition test group accepted shenqiong glucose injection200ml/d for7days.Both groups accepted total thyroidectomy.And nodular goiter cases were respectivelymarked as A1group8cases and B1group21cases.Thyroid cancer patients accepted totalthyroidectomy combined with the lymph node in central region cleaning,and wererespectively marked as A2group11cases and B2group35cases.Compare and analyse serumcalcium ion,PTH and symptom of hypocalcemia of preoperative,postoperative1st,3rd,5th,7thdays,1month of every group.Results:(1)All patients did not have permanent hypoparathyroidism and permanenthypocalcemia,and the ratio of temporary hypoparathyroidism was53.33%（40/75）.The ratioof hypoparathyroidism of the group only accepting total thyroidectomy was15.79%(3/19),andthe ratio of hypoparathyroidism of the group accepting total thyroidectomy combined withcleaning of lymph node in central region cleaning was66.07%.(2) The PTH ofpostoperative1st,3rd,5th,7th days,1month of A1group were less than preoperative′s,havingsignificant differences,and calcium ion level has no significant difference between the twogroups above.(3)The PTH and calcium ion level of postoperative1st,3rd,5th,7th days,1month of A2group were less than preoperative′s,having significant differences.(4)The PTHof postoperative1st,3rd,5th,7th days of B1group were less than preoperative′s,havingsignificant differences;the PTH of preoperative level and postoperative level has nosignificant difference;The calcium ion level of postoperative1st day of B1group was lessthan preoperative′s,having significant difference;and The calcium ion level betweenpreoperative and postoperative3rd,5th,7th days and1month had no significant differences.(5)The PTH and calcium ion level of postoperative1st,3rd,5th,7th days,1month of B2group were less than preoperative′s,having significant differences;the calcium ion level ofpostoperative1st,3rd,5th,7th days were less than preoperative′s,having significantdifferences,and the postopreative1month calcium ion level of had no significant differencethan preoperative′s.（6）The ratios of hypothyroidism of A1group and B1group were lessrepectively than A2group and B2group.Conclusions:(1)The surgery of total thyroidectomy and total thyroidectomy combinedwith cleaning of lymph node in central region are often prone to cause temporaryhypoparathyroidism after surgery, the latter one more often and more severe.Most patientsrecover from the hypoparathyroidism in1month,and rarely step into the permanenthypoparathyroidism.So total thyroidectomy combined with cleaning of lymph node in centralregion is relatively safe.(2) For only total thyroidectomy,the gluconate injection from onset ofoperation day can avoid hypocalcemia.For total thyroidectomy combined with cleaning oflymph node in central region,individual therayp is advocated;(3)The key to prevent patientsfrom hypoparathyroidism is protection of parathyroid gland in surgery.(4)For totalthyroidectomy combined wtih cleaning of lymph node in central region,shenqiong glucoseinjection has no obvious effect for parathyroid gland function recovery.