The Influencing Factors Of Hypoparathyroidism After Thyroid Surgery

Objective Hypoparathyroidism(HPT)usually occurs after neck surgery,especi ally after thyroid surgery,so there is need to investigate the facters of it in pati ents with thyroid papillary carcinoma(PTC).And it is beneficial to protect t he function of parathyroid gland in clinical work.Methods Retrospective analysis of patients who underwent surgical treatment for PTC in the First Affiliated Hospital of Shandong First Medical University from Aug ust 2014 to September 2018.A total of 696 patients(preoperatively hyperpar athyroidism,tumors of other sites,history of neck radiation and surgery,lack of clinical data,and severe dysfunction of other organs)were excluded and p atient data were collected.To investigate the relationship between sex,age,n odular goiter;surgical methods,lymph node excision in core region,hashimot o's thyroiditis,parathyroidgland transplantation and postoperative hypoparathyr oidism.According to the operation method patients were falled into four part s.Group A:ULTG+UCLND.Group B:TT+UCLND.Group C:TT+BCLND.Gro up D:TT+UCLND/BCLND+LCLND.The PTH and serum calcium before and 1 day after surgery were observed,and compare the incidence of low PTH and hypocalcemia rate at one day,six months after operation.If the parathyr oid hormone is lower than the normal reference value,it is considered to be hypoparathyroidism.If the level of PTH is lower after surgery,but returns to normal within six months or one year and there were no symptoms of hyp ocalcemia,the parathyroid gland function is considered to be Temporary hypo parathyroidism.If the low PTH levels or clinical symptoms were still exsists by the time of follow-up,the patientswere considered permanent parathyroid dy sfunction.Results Sex,age,nodular goiter or hashimoto's thyroiditis had no significant effect on the reduction of PTH on the first day after surgery(P>0.05).In term of the results,patients with bilateral central lymph node dissection were more likely to have lower PTH on the first day after surgery than patients with unilateral central lymph node dissection(P<0.05).There were 325 cases of parathyroid transplantation,and 204 cases of hypoparathyroidism one day after surgery(with an incidence of 62.77%).There were 371 patients without parathyroid implantation and 169 patients with hypoparathyroid function one day after surgery(with an incidence of 45.55%).Compared with patients without parathyroid resection,those with parathyroid resection were more likely to have hypoparathyroidism on the first day after surgery(P<0.05).According to the results of univariate and multivariate analysis,gender,PTG transplanting after resection,nodular goiter,and whether PTH was normal one day after surgery were independent influencing factors of hypocalcemia one day after surgery(P<0.05).The PTH value 1 day after the operation had a certain accuracy in predicting the permanent HP,and the zone under the curve is 0.815,P=0.001<0.05.10.72 is the critical point,PTH?10.72 pg/ml can be determined that there is no permanent HP.The specificity is 0.605 and the sensitivity is 1.The PPV was 3.4%and the NPV was 100%.According to the analysis of the effect of surgical methods on the level of PTH after operation,there were 373 patients with HP and 323 patients with normal function on the first day after operation.There were 333 cases with temporary hypoparathyroidism and 9 cases with permanent hypoparathyroidism,31 people were lost to follow-up.The incidence of transient low PTH and transient low serum calcium in group B?C?D was markedly higher than group A(P<0.001).On the first day after the surgery,PTH and serum calcium were remarkably higher than those in group B,C and D(P<0.001).The distinction among B,C and D groups are not obvious.On the first day after surgery,blood calcium and PTH are remarkably lower than they were before the surgery.(P<0.05).Conclution Dissection of lymph nodes in central region,parathyroid implantin g and selection of surgical methods can affect parathyroid function.Reduce th e possibility of parathyroid gland resection and the damage to the blood sup ply during the operation is beneficial to the protection of parathyroid gland f unction.About half of the patients developed hypoparathyroidism after surger y,and the PTH in most patients with hypoparathyroidism returned to normal within six months to a year,but a small number of patients still had perman ent damage to the parathyroid gland.Unilateral lobe of thyroid+unilateral c entral lymph node dissection has the least effect on parathyroid function,whi ch is preferred for low-risk patients.Individual treatment programs should be developed for different patients to reduce tumor recurrence and reduce the d amage to the parathyroid gland.