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Postoperative transient hypoparathyroidism occurred in cases Long-term hypoparathyroidism occurred in 21 cases 3. The OR value of gender male is 0. Table 2. Multivariate logistic regression analysis results of transient hypoparathyroidism. The OR value of combined lymphadenectomy was 1. Table 3. Multivariate logistic regression analysis results of long-term hypoparathyroidism. Hypoparathyroidism is one of the most common complications after thyroid surgery.
Surgery affects the parathyroid glands' blood supply, and direct damage to the parathyroid glands or miscut during the operation are the most common causes. In this study, the incidence of transient hypoparathyroidism was In patients undergoing bilateral total thyroidectomy, the following conclusions were obtained after multivariate logistic regression analysis: gender, combined lymphatic dissection, operation duration, maximum thyroid diameter, preoperative blood calcium, and transient hypoparathyroidism are related, Combined with lymphatic dissection, maximum thyroid diameter, and d1PTH are associated with long-term hypoparathyroidism.
Malignant thyroid tumors often require lymph node dissection. Related literature also shows that lymph node dissection in the central group can significantly increase the direct damage to the parathyroid glands or blood supply disorders during the operation 4. Patients underwent preventive neck lymph node dissection, and there is considerable controversy in domestic and foreign related literature. Some scholars believe that preventive dissection does not significantly reduce the probability of recurrence and metastasis and increases the risk of parathyroid injury.
This case study suggests that combined lymph node dissection is a risk factor for transient and long-term hypoparathyroidism, which is similar to the results of some studies at home and abroad 5.
Therefore, to reduce the damage to the parathyroid glands during lymph node dissection, it is necessary to perform lymph node dissection under the premise of standardized protection of the parathyroid glands and use nano carbon or other color reagents to color the parathyroid glands 6.
Regarding the size of the thyroid and the second operation, it is believed that the increase in the size of the thyroid and the difficulty of neck anatomy will cause the reduction of the surgical field and the difficulty of identifying and protecting the parathyroid glands 7. Therefore, for complicated operations, more attention should be paid to identifying, and protecting parathyroid glands. In univariate analysis, operation time was related to transient postoperative parathyroid hypoplasia, but it was excluded in multivariate analysis.
It should be explained that the difficulty of the operation played a leading role, leading to prolonged operation time. Preoperative blood calcium is the baseline of the patient's blood calcium level. This study used blood calcium more objective and PTH laboratory test indicators to determine hypoparathyroidism. In order to rule out some subjective factors, the main complaint of patients-related hypocalcemia symptoms was not used.
Therefore, the preoperative blood calcium index has a direct effect on whether the postoperative calcium is low. But this study also found that it does not correlate with long-term postoperative parathyroid hypoplasia. D1PTH impacts long-term hypoparathyroidism, and it can be used as a predictor of long-term hypoparathyroidism. For patients whose d1PTH is less than normal, calcium and vitamin D3 supplementation should be strengthened. If failing to get enough calcium supplements or close follow-up review, the patient may miss the chance of parathyroid function recovery.
Hypoparathyroidism after bilateral total thyroidectomy is common, and most of them are transient. Analog Devices Wiki Resources and Tools. Quick Start Guides.
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