Postoperative hypocalcemia is a most frequent complication following thyroidectomy in the patients presenting with non-toxic multinodular goiter. It may require long-term hospitalization, additional treatment, a large number of analyses, and frequent visits to outpatient facilities. The objective of the present study was to identify the predictors of postoperative hypoparathyroidism for the prevention of the development of hypocalcemia and its medicamental correction. The clinical data were collected prospectively during the period from October 2011 till May 2013. A total of 140 patients were available for the observation after thyroidectomy performed for the management of non-toxic multinodular goiter. Indications for the surgical intervention included cervical compression syndrome and a cosmetic defect. The patients were divided into two groups depending on the serum calcium level in the postoperative period. Group 1 (n=45) was comprised of the patients having the serum calcium level 2.00 mmol/l or lower, group 2 (n=95) included the patients showing the serum calcium level above 2.00 mmol/l. In addition, serum 25(OH) vitamin D and parathyroid hormone (PTH) levels were measured in all the patients pre- and postoperatively. The preoperative 25(OH)D level and postoperative calcium and PTH levels in the patients of group 1 were significantly lower than in group 2 (p=0.001). It was shown that the main prognostic factors of postoperative hypocalcemia are the preoperative 25(OH)D level below 15 ng/ml (p<0.001), postoperative PTH level below 10 pg/ml (p=0.01), and the age above 50 years (p=0.01). It is concluded that in the majority of the patients the age, the low serum 25(OH)D level in the preoperative period, and the low postoperative PTH level are significantly related to the development of postoperative hypocalcemia.

The aim of this prospective study was to determine the main factors influencing the development of postoperative hypocalcemia in patients with Gravesdisease after thyroidectomy. Assess whether patients with BG likely to develop postoperative hypocalcemia than those who performed thyroidectomy about nontoxiс multinodular goiter. In this study were prospectively included 54 patients with Gravesdisease, which from October 2011 to May 2013 was performed thyroidectomy. Additionally, as a control group from the database included 48 patients with nontoxiс multinodular goiter, who underwent thyroidectomy in the same time. All patients attended deficit/insufficiency of vitamin D (25(OH)D were 20/30 ng/ml). Patients were divided into 2 groups according to the postoperative calcium concentrations corrected for albumin in the blood: Group 1 - patients with postoperative levels of calcium in the blood of 2.0 mmol/l or less; Group 2 - Patients with blood calcium levels above 2.0 mmol/l. Thus, when patients Gravesdisease Group 1 disease duration was significantly higher concentration of 25(OH)D and postoperative parathyroid hormone was significantly lower compared to the 2nd group. According to logistic regression analysis, postoperative PTH level below 10 pg/ml was the main predictors of postoperative hypocalcemia ( p < 0,001). Patients with Gravesdisease increasingly requiring the appointment of calcium after the operation, they are demonstrating a significant clinical signs of hypocalcemia than patients with nontoxiс multinodular goiter after thyroidectomy.

The aim of this prospective study was to determine the main factors influencing the development of postoperative hypocalcemia in patients with Gravesdisease after thyroidectomy. Assess whether patients with BG likely to develop postoperative hypocalcemia than those who performed thyroidectomy about nontoxiс multinodular goiter. In this study were prospectively included 54 patients with Gravesdisease, which from October 2011 to May 2013 was performed thyroidectomy. Additionally, as a control group from the database included 48 patients with nontoxiс multinodular goiter, who underwent thyroidectomy in the same time. All patients attended deficit/insufficiency of vitamin D (25(OH)D were 20/30 ng/ml). Patients were divided into 2 groups according to the postoperative calcium concentrations corrected for albumin in the blood: Group 1 patients with postoperative levels of calcium in the blood of 2.0 mmol/l or less; Group 2 Patients with blood calcium levels above 2.0 mmol/l. Thus, when patients Gravesdisease Group 1 disease duration was significantly higher concentration of 25(OH)D and postoperative parathyroid hormone was significantly lower compared to the 2nd group. According to logistic regression analysis, postoperative PTH level below 10 pg/ml was the main predictors of postoperative hypocalcemia ( p

Postoperative hypocalcemia is the most frequent complication after thyroidectomy. One goal of our study was to investigate the parathyroid hormone (PTH) as the main predictor and early postoperative hypocalcemia. The study prospectively included 135 patients who from October 2011 to May 2013 was performed thyroidectomy. According to the results according to logistic regression analysis, postoperative PTH level below 10 pg/ml was the main predictor of postoperative hypocalcemia ( p

The objectives of this study was to identify the incidence of hypocalcemia, depending on the surgery and to examine the main predictors of postoperative hypocalcemia in patients with adenocarcinoma of the thyroid for medical treatment.Materials and Methods. Data were collected prospectively from 2011 to 2014. We analyzed 98 patients after surgical treatment for thyroid cancer. All patients underwent thyroidectomy, some patients without prophylactic сentral neck dissection ( n = 41, group A), and the proportion of patients with suspected metastatic lymph nodes more сentral neck dissection was performed ( n = 57, group B). Depending on the calcium concentration postoperative patients in groups A and B were further divided into two subgroups. In one subgroup of postoperative calcium level in the serum was 2.0 mmol/l or less, and in subgroup 2 exceeded2.0 mmol/l. Also, patients were determined in pre- and postoperative levels of 25 (OH) D, parathyroid hormone in the serum.Reults. Using logistic regression analysis showed that factors predictive postoperative hypocalcemia are: preoperative 25 (OH) D - less than 15 ng/ml ( p 0.001), postoperative PTH level in the blood serum - below 10 pg/ml ( p = 0.01).Conclusions. In most cases, age, low preoperative level of 25 (OH) D serum levels and low postoperative PTH level in blood serum is largely associated with the development of postoperative hypocalcemia. Among the factors influencing the development of postoperative hypocalcemia major role in the evaluation group played the volume of surgical intervention - a worst case was a combination of thyroidectomy with сentral neck dissection.

Postoperative hypocalcemia is the most frequent complication after thyroidectomy. One goal of our study was to investigate the parathyroid hormone (PTH) as the main predictor and early postoperative hypocalcemia. The study prospectively included 135 patients who from October 2011 to May 2013 was performed thyroidectomy. According to the results according to logistic regression analysis, postoperative PTH level below 10 pg/ml was the main predictor of postoperative hypocalcemia ( p 0,001). Sensitivity, specificity, positive and negative predictive value of PTH 10 pg / ml for predicting postoperative hypocalcemia were 71%, 99%, 97% and 86%, respectively. It can be concluded that measurement of PTH after 1 hour, and / or on the following day after thyroidectomy hypocalcemia predicts with high sensitivity, specificity. And early detection of PTH allows timely appoint agents calcium and vitamin D to prevent clinical manifestations of postoperative hypoparathyroidism.

Заболевания щитовидной железы (ЩЖ) среди всей патологии эндокринной системы занимают второе место после сахарного диабета, поражая в некоторых регионах более четверти населения. С ростом заболеваемости различными формами патологии ЩЖ растет число операций, в том числе и в непрофильных стационарах, что ведет к увеличению частоты послеоперационных осложнений. Одним из специфических осложнений операций на ЩЖ является гипопаратиреоз [6]. Гипопаратиреоз – недостаточность функции околощитовидных желез (ОЩЖ), характеризуется снижением уровня паратгормона (ПТГ) в крови с развитием гипокальциемии и гиперфосфатемии. Наиболее частой причиной гипопаратиреоза является удаление или нарушение кровоснабжения ОЩЖ во время операций на ЩЖ [71, 80]. Хроническая недостаточность ОЩЖ является одной из важнейших проблем клинической эндокринологии [33]. Снижение уровня кальция в крови у больных, оперированных по поводу заболеваний ЩЖ, нередко обусловлено повреждением или удалением ОЩЖ в ходе хирургического вмешательства, а также кровоизлиянием в них или развитием фиброзных процессов в месте операции в отдаленные сроки [3, 22]. Низкий уровень кальция до операции, невозможность визуализировать ОЩЖ во время операции, а также аутотрансплантация ОЩЖ ассоциированы с высоким риском развития гипопаратиреоза после тиреоидэктомии. Кроме того, обширное хирургическое вмешательство и технические трудности, такие как выраженная васкуляризация зоба (в том числе в случае болезни Грейвса – БГ) или необходимость билатерального лигирования нижней щитовидной артерии во время тиреоидэктомии, повышают риск возникновения послеоперационного гипопаратиреоза [51]. Методические подходы и арсенал терапевтических средств далеко не всегда способны обеспечить поддержание стабильного гомеостаза у больных с гипопаратиреозом, а также вызывают ряд побочных эффектов и осложнений (полиорганный кальциноз, катаракта, тетания, заболевания желудочно-кишечного тракта) [9, 11, 15, 16]. Транзиторный и стойкий гипопаратиреоз может приводить к возникновению различных осложнений у пациентов после тиреоидэктомии. Технически хорошо выполненная операция может предотвратить повреждение ОЩЖ [29]. Подход к лечению послеоперационного гипопаратиреоза основывается на выявлении пациентов из группы высокого риска еще на дооперационном этапе. Необходимо планирование операции в соответствии с этим риском с использованием таких технологий, как аутотрансплантация и криоконсервация ОЩЖ для предотвращения, а в дальнейшем и лечения гипопаратиреоза. Выявление ранних предикторов гипопаратиреоза позволяет осуществить правильный подход к лечению, а также продолженное амбулаторное наблюдение больного со стойким гипопаратиреозом. Такой подход позволяет предотвратить заболевания, связанные с гипопаратиреозом, и осложнения, ассоциированные с длительной терапией [5, 51].

Early diagnosis greatly facilitates successful treatment of medullary thyroid cancer. The present paper is designed to report the results of analysis of the studies carried out with the use of various diagnostic techniques and the data obtained during the long-term treatment of the patients with this pathology in the absence of biochemical remission.