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Vermeidung und Management des Hypoparathyreoidismus nach Schilddrüsenoperationen

Avoidance and management of hypoparathyroidism after thyroid gland surgery

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Zusammenfassung

Der postoperative Hypoparathyreoidismus nach beidseitigen Schilddrüsenoperationen oder nach Rezidiveingriffen wird laborchemisch als intaktes Parathormon (iPTH) < 15 pg/ml bei gleichzeitig normalem, niedrig normalem oder erniedrigtem Serumkalzium definiert. Die Diagnose ist durch eine einmalige Parathormonmessung 12 bis 24 h postoperativ sicher möglich und erlaubt bei einem iPTH ≥ 15 pg/ml die gefahrlose Entlassung. Patienten mit einem iPTH < 10 pg/ml müssen mit Kalzium/Vitamin D substituiert werde. Bei einem iPTH zwischen 10 und 15 pg/ml (Grauzone) kann darauf verzichtet werden, wenn durch eine 2. Bestimmung 48 h postoperativ der iPTH ≥ 15 pg/ml dokumentiert ist. Allerdings verlängert sich durch das Aussetzten der Substitution der Krankenhausaufenthalt. Patienten in der Grauzone müssen substituiert werden. Der Verlauf des iPTH-Spiegels allein entscheidet über die Notwendigkeit, Dosierung und Dauer einer Kalzium-/Vitamin-D-Substitution.

Abstract

Postoperative hypoparathyroidism after bilateral thyroid gland surgery or after interventions for recurrence is defined as intact parathyroid hormone levels (iPTH) < 15 pg/ml with simultaneous normal, below normal and markedly decreased serum calcium levels. After bilateral thyroid surgery and after reoperations a single iPTH measurement performed 12–24 h postoperatively can be used to predict parathyroid metabolism. Patients with an iPTH level ≥ 15 pg/ml may be discharged safely, patients with an iPTH < 10 pg/ml must be substituted with calcium and vitamin D and patients with an iPTH between 10 and 15 pg/ml (grey zone) may be discharged if a second measurement 48 h after surgery documents an iPTH ≥ 15 pg/ml. This procedure increases the length of hospital stay. Patients in the (grey zone) must be substituted. The iPTH level and its course determine the necessity, dose and length of calcium and vitamin D substitution.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. A. Selberherr und B. Niederle geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Sektion „Chirurgische Endokrinologie“, Abteilung für Allgemeinchirurgie, Universitätsklinik für Chirurgie, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090, Wien, Österreich

    A. Selberherr &  B. Niederle

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  1. A. Selberherr
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  2. B. Niederle
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Correspondence to B. Niederle.

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Selberherr, A., Niederle, B. Vermeidung und Management des Hypoparathyreoidismus nach Schilddrüsenoperationen. Chirurg 86, 13–16 (2015). https://doi.org/10.1007/s00104-014-2817-8

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  • DOI: https://doi.org/10.1007/s00104-014-2817-8

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