Uticaj hirurške traume na koncentraciju paratiroidnog hormona i kalcijuma u pacijenata podvrgnutih totalnoj tiroidektomiji kod benignih oboljenja štitaste žlezde

Abstract

The aim of this work is the determination of the most important clinicaly, pathological and biochemical risk factors for postoperative clinically relevant hypocalcemia. This clinical study is prospective and controlled. The study included one hundred patients at the Departement of General Surgery, Clinical Center of Nis, who underwent a total thyroidectomy for benign thyroid disease in general endotracheal anesthesia. The study assessed the intraoperative and postoperative PTH, calcium and phosphorus in patients who underwent a total thyroidectomy. It was performed risk assessments for the occurrence of postoperative hypocalcemia therapy and prognosis for these patients. The results showed that there are significant biochemical and clinical parameters that influence the occurrence of postoperative hypocalcemia. Characteristics associated with a hypocalcemia were: preoperatively measured values of calcium, vitamin D and calcitonin, PTH and weight gland. Reduction in PTH by 1% increases the risk of intraoperative hypocalcemia 4.9%. Increasing calcium levels preoperatively to 1 mmol/L reduces the risk of intraoperative hypocalcemia by 100%, while any increase in the value of preoperative vitamin D reduces the risk of intraoperative hypocalcemia by 11.9% Increased preoperative calcitonin measured level of 1 pg/ml reduces the risk of hypocalcemia 12 hours after surgery by 66.1%, increasing the level of preoperative calcitonin for 1 pg/ml reduce the risk of hypocalcemia registered 24 hours after surgery by 97%, whereas any increase in weight removed the thyroid gland to 1g increase the risk of intraoperative hypocalcemia by 9,8%. Calcium levels postoperatively reached the lowest level after 12 hours (total of 78 patients have lowered calcium), and then begins to rise, and the number of patients with reduced calcium begins to decrease. Surgical trauma has increased the number of patients with hypocalcemia. There were a maximum of 64% 12 hours after total thyroidectomy. After that, the presence of hypocalcemia among respondents reduced and calcium normalizes within two months postoperatively.