Clinical Significance Of Intraoperative Parathyroid Index Grades In Total Thyroidectomy

ObjectiveTo predict postoperative parathyroid hormone levels and the risk of hypoparathyroidism and evaluate the postoperative calcium supplementation time by grading the parathyroid glands after patients performed total thyroidectomy.Meanwhile,to provide theoretical basis for the clinical application of parathyroid auto-transplantation by analyzing the risk of postoperative hypoparathyroidism between parathyroid transplantation group and non-transplantation group.MethodsWe observed the clinical case information of patients undergone total thyroidectomy and central lymph node dissection in the same thyroid surgery group of Fujian Medical University Union Hospital from January 2015 to November 2016.The same scoring system was applied to evaluate parathyroid scores(0-3 points).Parathyroid grades(0-1 point Grade I;1-2 points Grade II;2-3 points Grade III)were identified according to the mean of the total parathyroid score.The levels of serum calcium and serum parathyroid hormone before operation and 1 day,2 weeks,2 months and 6 months after operation were recorded to analyze the correlation between parathyroid index grade and the postoperative serum PTH and serum calcium.To observe the incidences of transient hypoparathyroidism and permanent hypoparathyroidism after surgery,and record postoperative calcium supplementation time.The patients were divided into transplantation group and non-transplantation group according to whether parathyroid auto-transplantation was performed during surgery.The statistical differences in the levels of serum PTH and serum calcium and the risk of hypoparathyroidism were observed between two groups after operation.Results1.246 patients were included in the research.There were 28 patients with Grade I,98 patients with Grade II,and 120 patients with Grade III.There were 197 cases of temporary hypoparathyroidism and 9 cases of permanent hypoparathyroidism.In each grade(Grade I,Grade II,and Grade III),25 cases,84 cases and 87 cases were temporary hypoparathyroidism respectively,and 0 case,5 cases and 4 cases were permanent hypoparathyroidism.2.Intraoperative parathyroid index grades was positively correlated with PTH 1 day,2 weeks,2 months and 6 months after operation.The correlation coefficient r was 0.326(95%CI 0.210~0.440,P=0.000<0.05)?0.186(95%CI 0.068~0.318?P=0.003<0.05)?0.248(95%CI 0.133~0.354,P=0.000<0.05)?0.231(95%CI 0.110~0.342,P=0.000<0.05).3.There were statistical differences in temporary hypoparathyroidism(P=0.022<0.05),postoperative hospital days(P=0.000<0.05)and calcium supplementation time(P=0.000<0.05)among the grades of intraoperative parathyroid index grades.The significance is that the higher the grade was,the lower the incidence of temporary hypoparathyroidism after surgery was,and the shorter the length of hospital stay was and calcium supplementation was.There was no significant difference in postoperative permanent hypoparathyroidism among the grades of intraoperative parathyroid index grades(P=0.703>0.05).4.Among the transplantation group and non-transplantation group,the incidence of temporary hypoparathyroidism was respectively 85.08% and 64.62%,and there were significant differences(P=0.000 < 0.05).The incidence of permanent hypoparathyroidism was respectively 2.76%,6.15% and the difference was not statistically significant(P=0.249 > 0.05)between the transplantation group and non-transplantation group.Conclusions1.Intraoperative parathyroid index grades in total thyroidectomy was positively correlated with postoperative serum PTH level.The higher the grade was,the higher the serum PTH level was and the lower the risk of temporary hypoparathyroidism was.2.There was no significance between parathyroid index grades and postoperative serum calcium in total thyroid surgery affected by calcium supplement.3.There was a statistically significant difference in the time of calcium supplementation among grades of intraoperative parathyroid index grades during thyroid surgery,which can guide the oral calcium administration schedule and time and reduce the occurrence of hypocalcemia.4.Intraoperative parathyroid auto-transplantation increased the risk of temporary hypoparathyroidism,but the risk of postoperative permanent hypoparathyroidism was not statistically significant in the single-center and small-sample study.