Total tiroidektomi olan hastalarda postoperatif hipoparatiroidi riskinin çoklu ölçümle belirlenmesi
Determination of postoperative hypoparathyroidy risk in patients undergoing total thyroidectomy with multiple measurements
- Tez No: 945764
- Danışmanlar: PROF. DR. İMDAT YÜCE
- Tez Türü: Tıpta Uzmanlık
- Konular: Kulak Burun ve Boğaz, Otorhinolaryngology (Ear-Nose-Throat)
- Anahtar Kelimeler: Belirtilmemiş.
- Yıl: 2025
- Dil: Türkçe
- Üniversite: Erciyes Üniversitesi
- Enstitü: Tıp Fakültesi
- Ana Bilim Dalı: Kulak Burun Boğaz Hastalıkları Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 73
Özet
Giriş ve Amaç: Endokrin tümörleri arasında en sık görüleni tiroid kanserleridir. Tiroid kanserleri, tüm kanserlerin 15 pg/mL ve postoperatif PTH düzeyi preoperatif seviyesine göre %65'ten az düşenler veya ameliyat öncesi PTH düzeyine göre ameliyat sonrası PTH düzeyi artan hastalar ise hipoparatiroidi gelişmeyen hasta grubuna dahil edildi. Hipoparatiroidi gelişen hastaların takiplerde bir sene içerisinde PTH seviyesi normal sınırlara yükselenleri geçici hipoparatiroidi grubuna dahil edildi. Kalıcı hipoparatiroidi hasta grubuna ameliyat sonrası hipoparatiroidi gelişip takiplerde bir sene içinde PTH seviyesi normal sınırın altında olanlar dahil edildi. Bulgular: Çalışmaya dahil edilen hastaların %76,3'ü kadın, %23,7'si erkek hastalardan oluşmaktaydı. Hastaların %40,1'inde (83 hasta) hipoparatiroidi gelişti. Hipoparatiroidi gelişen hastaların %35,7'sini geçici hipoparatiroidi gelişen bireyler ve %4,3'ünü ise kalıcı hipoparatiroidi gelişen bireyler oluşturmaktaydı. D vitamini ile hipoparatiroidi gelişimi arasında istatiksel ilişki bulunmadı (p=0,693). Çalışmada hastaların demografik özellikleri ile hipoparatiroidi gelişmeyen ve gelişen bireyler arasında istatistiksel ilişki bulunamadı (p>0.05). Hipoparatiroidi gelişen hastalarda preoperatif T3 düzeyi ortalaması, hipoparatiroidi gelişmeyen hastaların preoperatif T3 düzeyi ortalama değerinden düşük olduğu gözlendi ve preoperatif T3 değeri ile hipoparatiroidi arasında anlamlı istatiksel ilişkisi bulundu (p=0,047). Ameliyat öncesi dönemde takviye olarak kalsiyum veya D vitamini alma durumu ile hipoparatiroidi grupları arasında anlamlı istatistiksel ilişki bulundu (p=0,005). Patoloji raporunda spesmende paratiroid dokusu tespit edilmesi hipoparatiroidi riskini artırdığı tespit edildi (p=0,01). Preoperatif Ca+⁺, albümin, T4, TSH, fosfor, alkalen fosfataz, D vitamini, magnezyum, preoperatif dönemde tiroid ilacı kullanma durumu, paratiroid bez otoimplatasyonu varlığı ve retrosternal viii uzanım durumu ile hipoparatiroidi arasında anlamlı istatistiksel ilişki bulunmadı (p
Özet (Çeviri)
Introduction and Aim: Thyroid cancers represent the most prevalent type of endocrine tumors. Fewer than 1% of all malignancies are attributed to thyroid cancer. Total thyroidectomy is widely accepted as the standard treatment for primary malignant lesions of the thyroid gland as well as for certain benign conditions. The most common complication following total thyroidectomy surgery is hypoparathyroidism, which has a multifactorial pathogenesis. Early and accurate detection of hypoparathyroidism offers several advantages, including improved postoperative patient safety, reduced length of hospital stay, decreased treatment costs, and reduced anxiety for the surgeon regarding postoperative complications.The aim of this study is to compare preoperative and postoperative parathyroid hormone (PTH) levels in patients undergoing total thyroidectomy, and to identify the risk of developing postoperative hypoparathyroidism at the earliest possible stage after surgery. Methods: A total of 207 patients who underwent total thyroidectomy or total thyroidectomy combined with neck dissection between June 21, 2021, and April 26, 2024, at the Department of Otorhinolaryngology and Head and Neck Surgery of Erciyes University Medical Faculty were prospectively evaluated. Patient data such as sex, age and body mass index (BMI) were recorded. Preoperative laboratory values, including vitamin D levels, thyroid function tests, calcium (Ca²⁺), albumin, phosphorus, magnezium, alkaline phosphatase, any medications used before surgery, and parathyroid hormone (PTH) levels obtained within 72 hours prior to the procedure, were documented. Following removal of the second thyroid lobe during surgery, PTH levels were measured at exactly 2 and 3 hours postoperatively. Additionally, calcium and albumin levels were recorded on the day of surgery (postoperative day 0), and on the first and second postoperative days. Intraoperative findings, such as the type of surgical procedure performed, retrosternal extension of the thyroid lobes, whether parathyroid glands were preserved, and whether auto-implantation of parathyroid tissue was performed, were also x noted. Postoperative monitoring included documentation of whether oral or intravenous calcium carbonate and calcitriol were initiated, any complications that developed, and patient complaints. The final pathology report was reviewed to determine whether the diagnosis was benign or malignant, whether parathyroid tissue was present in the specimen, and, in malignant cases, the number of metastatic lymph nodes. Patients who had previously undergone thyroid surgery, neck dissection, received radiotherapy (RT) to the neck, received chemotherapy (CT), underwent hemithyroidectomy, failed to attend regular follow-ups, or declined participation in the study were excluded. Patients were divided into four categories: those with postoperative hypoparathyroidism, those without, those with transient hypoparathyroidism, and those with permanent hypoparathyroidism. The relationship between the collected data and each group was analyzed. Postoperative 2nd and 3rd hour PTH levels were compared with preoperative PTH levels. Patients with PTH levels 15 pg/mL and a drop of less than 65%, or whose postoperative PTH levels increased compared to preoperative levels, were classified as not having developed hypoparathyroidism. Patients whose PTH levels returned to normal limits within one year of follow-up were placed in the transient hypoparathyroidism group. Patients who continued to have subnormal PTH levels one year after surgery were classified as having permanent hypoparathyroidism. Results: Among the study participants, the majority (76.3%) were female, and 23.7% were male. Hypoparathyroidism developed in 40.1% of the patients (83 patients). Among those who developed hypoparathyroidism, 35.7% had transient hypoparathyroidism and 4.3% had permanent hypoparathyroidism. There was no statistically significant association between vitamin D levels and the occurrence of hypoparathyroidism (p=0.693). In addition, demographic variables showed no significant correlation with the development of hypoparathyroidism (p>0.05). It was observed that the mean preoperative T3 level was lower in patients who developed hypoparathyroidism compared to those who did not, and a statistically significant relationship was found between preoperative T3 levels and hypoparathyroidism (p=0.047). Preoperative use of calcium or vitamin D supplements was not significantly associated with the development of hypoparathyroidism (p=0.617). The detection of parathyroid tissue in the surgical xi specimen (reported by pathology) was significantly correlated with the occurrence of hypoparathyroidism (p=0.01). No significant associations were found between hypoparathyroidism and the following variables: preoperative calcium, albumin, T4, TSH, phosphorus, alkaline phosphatase, vitamin D, magnezium levels, medication use, presence of parathyroid gland auto-implantation, or retrosternal extension of the thyroid. PTH levels measured at the 2nd and 3rd postoperative hours showed a statistically significant difference among patients who did not develop hypoparathyroidism, those who developed transient hypoparathyroidism, and those who developed permanent hypoparathyroidism (p
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