Paratormônio das primeiras 8 horas pós-tireoidectomia como preditor de hipocalcemia: um estudo prospectivo
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Data
2021-06-24
Autores
Soares, Carlos Segundo Paiva
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Universidade Estadual Paulista (Unesp)
Resumo
Dentre as complicações da tireoidectomia, a hipocalcemia é a mais frequente, apresentando grande dificuldade de predição. Seu manejo varia muito de serviço para serviço, não havendo uma conduta universalmente aceita. Objetivos: Avaliar a capacidade das concentrações séricas do paratormônio (PTH) nas primeiras 8 horas após a tireoidectomia total (TT) ou totalização de tireoidectomia (ToT), de detectar os pacientes que evoluirão com hipocalcemia e aqueles que necessitarão da reposição de cálcio (Ca). Casuísticas e Métodos: Foram avaliados 107 pacientes submetidos a TT ou ToT, prospectivamente, com dosagem de PTH no pré-operatório (PreO) e na 1a e 8a hora (h) de PO; e de Ca no PreO e com 1, 8, 14, 24, 30, 36, 42 e 48h de PO, além de quanto a outros parâmetros laboratoriais, demográficos, clínicos/cirúrgicos, anatomopatológicos e evolutivos. Os principais desfechos foram a hipocalcemia e a necessidade de reposição de Ca no PO, enquanto que as principais variáveis de interesse foram as concentrações séricas do PTH coletado na 1a e 8a h de PO. Os pacientes foram divididos em grupos normo ou hipocalcêmico, e com ou sem necessidade de reposição de Ca, e esses grupos foram comparados entre si quanto aos diferentes parâmetros avaliados. Posteriormente, foram realizadas análises uni e multivariadas para os desfechos. Para as variáveis preditoras, foram calculados a área sob a curva ROC e os pontos de melhor sensibilidade e especificidade para a predição dos desfechos. Resultados: Dos pacientes avaliados, 70,1% e 40,2% evoluíram, respectivamente, com hipocalcemia e necessidade de reposição de Ca. Foram preditores de hipocalcemia o PTH PreO, da 1a e 8a h de PO, o magnésio (Mg) do 1o PO e a ToT; e de necessidade de reposição de Ca o PTH da 1a e 8a h de PO, o Ca da 1a h e o fósforo (P) do 1o dia de PO. O cutoff do PTH de 9,7 e 8,22 pg/mL, na 1a h de PO, e de 11,2 e 8 pg/mL, na 8a h de PO, apresentaram, respectivamente, acurácia de 75,9% e 83,9%; e de 72,7% e 84,8%, com sensibilidade de 72,4% e 90,2%; e de 67,1% e 89,7% em predizer hipocalcemia e necessidade de reposição de Ca. Quando combinados, a acurácia e sensibilidade em predizer necessidade de reposição de Ca foram, respectivamente, de 84,9% e 91,9%. Conclusão: As concentrações séricas do PTH, coletadas na 1a e 8a h de PO, foram preditoras de hipocalcemia e da necessidade de reposição de Ca após TT ou ToT.
Among the complications of thyroidectomy, hypocalcemia is the most frequent, presenting great difficulty in prediction. Its management varies greatly from service to service, and there is no universally accepted conduct. Objectives: To evaluate the ability of serum concentrations of parathormone (PTH) in the first 8 hours (h) after total thyroidectomy (TT) or totalization of thyroidectomy (ToT), to detect patients who will develop hypocalcemia and those who will need replacement of calcium (Ca). Casuistry and Methods: 107 patients who underwent TT or ToT were prospectively evaluated with PTH dosage in the preoperative period (PreO) and in the 1st and 8th postoperative hours; and Ca in PreO and with 1, 8, 14, 24, 30, 36, 42 and 48 h of PO, in addition to other laboratory, demographic, clinical / surgical, anatomopathological and evolution parameters. The main outcomes were hypocalcemia and the need for Ca replacement in the PO, while the main variables of interest were the serum concentrations of PTH collected in the 1st and 8th hours of PO. The patients were divided into normal or hypocalcemic groups, with or without the need for Ca replacement, and these groups were compared with each other regarding the different parameters evaluated. Subsequently, univariate and multivariate analyzes were performed for the outcomes. For the predictor variables, the area under the ROC curve and the points of best sensitivity and specificity for the prediction of outcomes were calculated. Results: Of the evaluated patients, 70.1% and 40.2% evolved, respectively, with hypocalcemia and need for Ca replacement. Predictors of hypocalcemia were PTH PreO, from the 1st and 8th hours of PO, magnesium (Mg) from 1st PO and ToT; and the need for replacement of Ca the PTH of the 1st and 8th hours of PO, the Ca of the 1st hour and the phosphorus (P) of the 1st day of PO. The PTH cutoff of 9.7 and 8.22 pg/mL, in the 1st h of PO, and 11.2 and 8 pg / mL, in the 8th h of PO, presented, respectively, accuracy of 75.9% and 83.9%; and 72.7% and 84.8%, with a sensitivity of 72.4% and 90.2%; and 67.1% and 89.7% in predicting hypocalcemia and the need for Ca replacement. When combined, the accuracy and sensitivity in predicting the need for Ca replacement were 84.9% and 91.9%, respectively. Conclusion: Serum PTH concentrations, collected in the 1st and 8th hours of PO, were predictors of hypocalcemia and the need for Ca replacement after TT or ToT.
Among the complications of thyroidectomy, hypocalcemia is the most frequent, presenting great difficulty in prediction. Its management varies greatly from service to service, and there is no universally accepted conduct. Objectives: To evaluate the ability of serum concentrations of parathormone (PTH) in the first 8 hours (h) after total thyroidectomy (TT) or totalization of thyroidectomy (ToT), to detect patients who will develop hypocalcemia and those who will need replacement of calcium (Ca). Casuistry and Methods: 107 patients who underwent TT or ToT were prospectively evaluated with PTH dosage in the preoperative period (PreO) and in the 1st and 8th postoperative hours; and Ca in PreO and with 1, 8, 14, 24, 30, 36, 42 and 48 h of PO, in addition to other laboratory, demographic, clinical / surgical, anatomopathological and evolution parameters. The main outcomes were hypocalcemia and the need for Ca replacement in the PO, while the main variables of interest were the serum concentrations of PTH collected in the 1st and 8th hours of PO. The patients were divided into normal or hypocalcemic groups, with or without the need for Ca replacement, and these groups were compared with each other regarding the different parameters evaluated. Subsequently, univariate and multivariate analyzes were performed for the outcomes. For the predictor variables, the area under the ROC curve and the points of best sensitivity and specificity for the prediction of outcomes were calculated. Results: Of the evaluated patients, 70.1% and 40.2% evolved, respectively, with hypocalcemia and need for Ca replacement. Predictors of hypocalcemia were PTH PreO, from the 1st and 8th hours of PO, magnesium (Mg) from 1st PO and ToT; and the need for replacement of Ca the PTH of the 1st and 8th hours of PO, the Ca of the 1st hour and the phosphorus (P) of the 1st day of PO. The PTH cutoff of 9.7 and 8.22 pg/mL, in the 1st h of PO, and 11.2 and 8 pg / mL, in the 8th h of PO, presented, respectively, accuracy of 75.9% and 83.9%; and 72.7% and 84.8%, with a sensitivity of 72.4% and 90.2%; and 67.1% and 89.7% in predicting hypocalcemia and the need for Ca replacement. When combined, the accuracy and sensitivity in predicting the need for Ca replacement were 84.9% and 91.9%, respectively. Conclusion: Serum PTH concentrations, collected in the 1st and 8th hours of PO, were predictors of hypocalcemia and the need for Ca replacement after TT or ToT.
Descrição
Palavras-chave
Cálcio, Hipocalcemia, Hormônio paratireóideo, tireoidectomia, Calcium, Hypocalcemia, Parathyroid hormone, Thyroidectomy