摘要 :
OBJECTIVES/BACKGROUND: The aim of this study is to investigate the predictive value of intraoperative parathormone measurement addressing successful surgical resection in patients with secondary hyperparathyroidism. METHODS: The s...
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OBJECTIVES/BACKGROUND: The aim of this study is to investigate the predictive value of intraoperative parathormone measurement addressing successful surgical resection in patients with secondary hyperparathyroidism. METHODS: The study included 42 consecutive patients operated on between May 2006 and July 2008. Patients were grouped according to successful surgery (Group 1, n = 36) and persistent postoperative hyperparathyroidism (Group 2, n = 6). Serum phosphorus (P), total calcium (tCa), ionized calcium (iCa), intact parathormone (iPTH), and alkaline phosphatase (ALP) were drawn preoperatively and intraoperatively upon 15 minutes after completion of resection (iPTH(15)). The rate of decrease of pith detected by iPTH(15) compared to preoperative values was calculated (iPTH(%)). RESULTS: Preoperative P, tCa, iCa, iPTH, and ALP were comparable. Subtotal parathyroidectomy (sPx) (n = 27) and total parathyroidectomy with autotransplantation (tPx) (n = 15) were performed. Mean iPTH(15) value, iPTH(%) rates were 145.9 +/- 12.3 pg/mL, % 91.6 +/- 0.7, and 522.5 +/- 85.4 pg/mL, % 75.1 +/- 2.0 (P = ,001) in Groups 1 and 2, respectively. Mean serum tCa and iCa at POD#1 in Group 1 were 7.6 +/- 0.1 mg/dL, 0.910 +/- 0.4 mmol/L, and Group 2 were 8.3 +/- 0.3 mg/dL, 1.050 +/- 0.4 mmol/L (P < .05), respectively. ALP levels were similar. CONCLUSION: iPTH(15) value and iPTH(%) rate accurately predicts the completeness of resection in secondary hyperparathyroidism. The rate of decrease in serum iPTH detected intraoperatively compared to preoperative baseline levels exceeding 90% in sPx, 95% in tPx, accurately predicts the success of surgery. Postoperative normocalcemia without calcium replacement would raise a suspicion about completeness of surgical resection.
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摘要 :
OBJECTIVES/HYPOTHESIS: The goal of this study was to investigate the effects of routine thyroid gland palpation on serum thyroid hormone levels. STUDY DESIGN: Prospective study at Haydarpasa Numune Research and Education Hospital,...
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OBJECTIVES/HYPOTHESIS: The goal of this study was to investigate the effects of routine thyroid gland palpation on serum thyroid hormone levels. STUDY DESIGN: Prospective study at Haydarpasa Numune Research and Education Hospital, Istanbul, Turkey. METHODS: This study was carried out in two groups with a total of 50 consecutive adults. Group I consisted of 20 patients (12 female and 8 male, aged 20-48 years) with a diagnosis of nodular thyroid disease confirmed by ultrasound imaging techniques. The second group consisted of 30 otherwise healthy subjects (17 female and 13 male, aged 18-50 years) referred for neck and thyroid ultrasound and with no thyroid pathology detected. Thyroid gland palpations were performed by the same physician. Blood samples were obtained before and 2 hours after thyroid gland palpation. Serum total T3 (TT3), total T4 (TT4), free T3 (FT3), free T4 (FT4), thyroid stimulating hormone (TSH), and thyroglobulin (TG) measurements were made. RESULTS: We found that routine palpation in the first group caused a significant increase in serum TT3 (P < .05), FT3 (P < .01), FT4 (P < .05), and TG (P < .05) levels. In the second group, TT3 (P < .01), FT3 (P < .05), FT4 (P < .05), and TG (P < .05) levels also increased significantly after palpation. Differences in TSH and TT4 levels were not significant in any of the groups (P > .05). CONCLUSIONS: Preliminary data proposing a possible effect of routine thyroid gland palpation on serum thyroid hormone levels suggest that serum thyroid hormone measurements should be performed before any manipulation of the gland, including palpation, to avoid misdiagnosis.
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