Orientador: Gláucia Maria Ferreira da Silva Mazeto / Coorientador: José Vicente Tagliarini / Resumo: Introdução: As concentrações séricas pós-operatórias de cálcio (Ca) ou paratormônio (PTH) têm sido aventadas como preditoras de hipoparatireoidismo após tireoidectomia total (TT). Porém, ainda não foram estabelecidos padrões mundialmente aceitos para tal fim. Objetivos: Identificar precocemente o hipoparatireoidismo pós-operatório, em pacientes submetidos à TT, por meio da dosagem de Ca e PTH séricos nas primeiras 24 horas após a cirurgia. Casuística e Métodos: Foram estudados, prospectivamente, 76 pacientes operados entre 2013 e 2014. Foram dosados Ca sérico na véspera, durante a TT, com 1, 8, 14 e 24 horas (h) de pós-operatório (PO), e PTH antes, durante, com 1 e 8h PO. Os pacientes foram reavaliados com 7, 30 dias e com 6 meses PO e classificados como: sem hipoparatireoidismo (SH), com hipoparatireoidismo temporário (HT) ou com hipoparatireoidismo permanente (HP). Resultados: 40 pacientes (52,6%) foram incluídos no SH, 24 (31,6%) no HT e 12 (15,8%) no HP. O sexo feminino foi mais prevalente nos três grupos [SH: 85%; HT: 91,7%; HP:100%; p<0,05], e apresentou maior risco para HP [risco relativo (RR)=1,14 (IC 95%:1,04-1,25)]. As curvas de Ca mostraram padrão descendente em todos os grupos, mais acentuado no HP (p<0,05), com slope significativo para os grupos a partir das 8h (p<0,05). Com 24h PO, slope negativo de Ca maior que 10% determinou maior risco para HT [RR=2,00 (IC 95%:1,05-3,18)], enquanto que slope negativo maior que 20% se associou a maior risco de HP [RR=3,89 (IC ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: The post-operative serum concentrations of calcium (Ca) or parathyroid hormone (PTH) have been suggested as predictors of hypoparathyroidism after total thyroidectomy (TT). However, no patterns have yet been established for this purpose. Aims: To identify post-operative hypoparathyroidism early in patients submitted to TT, by means of serum Ca and PTH dosage in the first 24 hours after surgery. Patients and methods: A prospective study was conducted of 76 patients operated in the period between 2013 and 2014. Serum Ca was dosed on the eve of, during TT, and at 1, 8, 14 and 24 hours (h) post-operatively (PO), and PTH dosed before, during and at 1 and 8h PO. The patients were re-evaluated at 7, 30 days, and 6 months PO, and classified as follows: without hypoparathyroidism (WH), with temporary hypoparathyroidism (TH) or with permanent hypoparathyroidism (PH). Results: Forty (40) patients (52.6%) were included in WH; 24 (31.6%) in TH; and 12 (15.8%) in PH. The female gender was more prevalent in the three groups [WH: 85%; TH: 91.7%; PH:100%; p<0.05], and presented higher risk for PH [Relative Risk (RR)=1.14 (IC 95%:1.04-1.25)]. The Ca curves showed a descending pattern in all groups, but more accentuated in PH (p<0.05), with a significant slope for the groups as from 8h (p<0.05). At 24h PO, negative Ca slope greater than 10% determined higher risk for TH [RR=2.00 (IC 95%:1.05-3.18)], while a negative Ca slope greater than 20% was associated with higher risk for PH [RR=3.89 (IC 95%:1.42-7.47)]. PTH already showed a drop in absolute values during TT (G3>G2>G1; p<0.05). At 8h, the mean percentage drop in PTH was 100% for the cases with PH (p<0.01). A negative PTH slope greater than 75% was associated with higher risk for TH [RR=2.24 (IC 95%:1.16-3.42), during TT; RR=2.24 (IC 95%:1.16-3.42), at 1h; and RR=3.07 (IC 95%:1.82-4.57), at 8h], while a negative... (Complete abstract electronic access below) / Doutor
| Identifer | oai:union.ndltd.org:UNESP/oai:www.athena.biblioteca.unesp.br:UEP01-000874411 |
| Date | January 2016 |
| Creators | Tunes, Roberto Santos. |
| Contributors | Universidade Estadual Paulista "Júlio de Mesquita Filho" Faculdade de Medicina. |
| Publisher | Botucatu, |
| Source Sets | Universidade Estadual Paulista |
| Language | Portuguese |
| Detected Language | English |
| Type | computer file |
| Relation | Modo de acesso: Internet |
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