Analysis Of Related Factors Of Hypoparathyroidism After Total Thyroidectomy

Objective:To analyze the risk factors and predictors of hypoparathyroidism after total thyroidectomy and explore the nutritional status of vitamin D in patients with thyroid nodules and its effect on hypoparathyroidism after total thyroidectomy.Explore the effects of intraoperative carbon nanoparticles on parathyroid glands protection.Methods:200 patients with thyroid diseases who underwent total thyroidectomy at Department of General Surgery,Ruijin Hospital,School of Medicine,Shanghai Jiaotong University from September 2012 to October 2015 were followed up and analyzed retrospectively,the related factors were analyzed.The clinical data of 1675 patients with thyroid nodules from December 2010 to 2015 in the Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine were collected,explore the nutritional status of vitamin D in patients with thyroid nodules.The clinical data of 116 patients with thyroid carcinoma undergoing total thyroidectomy plus bilateral central neck dissection were selected to study the effect of preoperative vitamin D deficiency and insufficiency on postoperative hypoparathyroidism.From September 2015 to February 2016,100 patients in Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine with thyroid carcinoma undergoing primarily total thyroidectomy plus bilateral central neck dissection were collected,explore the effects of intraoperative carbon nanoparticles on parathyroid glands protection.Results:Of the 200 patients,66.5%developed hypoparathyroidism on the first day,6.5%developed hypoparathyroidism in 6 months after surgery.The incidence of hypoparathyroidism postoperative 1 year was 3.5%.The female gender（OR=2.966,95%CI:1.480-5.945,P=0.002）,age（OR=0.972,95%CI:0.946-0.999,P=0.039）,and bilateral center lymph node dissection（OR=5.508,95%CI:1.693-17.923,P=0.005）were independently correlated with postoperative hypoparathyroidism.The parathyroid hormone concentration on postoperative day 1（OR=0.738,95%CI:0.556-0.979,P=0.035）and ¹³¹I remnant ablation therapy（OR=12.887,95%CI:3.434-48.367,P=0.000）were independent risk factors for postoperative hypoparathyroidism in 6 month.¹³¹I remnant ablation therapy（OR=5.636,95%CI:1.121-28.339,P=0.036）was independent risk factors for postoperative hypoparathyroidism in 1 year.Both iPTH1d<3.05 pg/mL and%iPTH decline>92.%could accurately predict significant hypoparathyroidism postoperative 6 month with accuracy of 82.1%and78.2%.1675 patients with vitamin D sufficiency（more than 75.0nmol/L）,vitamin D insufficiency（50.0-74.9 nmol/L）,deficiency（25.0-49.9 nmol/L）,vitamin D severe deficiency（<25.0 nmol/L）accounted for5.6%,26.5%,54.2%,13.7%,respectively.There were significant differences in the average level of vitamin D between male（46.89±18.82 nmol/L）and female（42.82±18.09nmol/L）.The average level of vitamin D in（≤45years）group、（45-60 years）group、（≥60years）group were 41.27±16.55nmol/L、44.48±17.68nmol/L、48.88±22.14nmol/L respectively.There were significant differences between the groups（P<0.05）.Of the 116 patients,the postoperative hypocalcemia rates in vitamin D severe deficiency、deficiency、insufficiency、sufficiency group were 38.9%,26.4%,18.2%,25%.There was no significant differences between the groups（P>0.05）.The serum calcium values of these groups were 2.05±0.14 mmol/L、2.07±0.14 mmol/L、2.06±0.15 mmol/L、2.11±0.21mmol/L respectively.There was no significant difference between the groups（P>0.05）.Of the 100 patients,the amount of PTH 1d and the decrease of PTH discrepancy between the two groups was not differences（t=0.23,P>0.05）,（t=1.04,P>0.05）..Conclusion:Vitamin D insufficiency and deficiency are widely prevalent in patients with thyroid nodules,which is more severe in females.Vitamin D insufficiency and deficiency in youth and middle-aged people can not be ignored.Preoperative vitamin D deficiency and insufficiency had no significant effect on hypocalcemia after total thyroidectomy.Bilateral center lymph node dissection and ¹³¹I remnant ablation therapy are risk factors for postoperative hypoparathyroidism,The iPTH1d and%iPTH decline can predict hypoparathyroidism postoperative 6 month.Carbon nonoparticle has no significant effect on the protection of parathyroid function in total thyroidectomy.