Koncentracije kalcija i paratireoidnog hormona u ranom postoperativnom periodu nakon zahvata na štitnjači

master's thesis

• Title (english): Calcium and parathyroid hormone concentrations in the early postoperative period after the thyroid gland operation
• Author: Anna-Maria Vidaković
• Mentor: Nada Vrkić (mentor)
• Committee member: Nada Vrkić (predsjednik povjerenstva)
• Committee member: Olga Gornik (član povjerenstva)
• Committee member: Sandra Šupraha Goreta (član povjerenstva)
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; (Department of medical biochemistry and haematology); Zagreb
• Defense date and country: 2017-09-29, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Medical Biochemistry

Abstract

Homeostaza kalcija u organizmu je regulirana paratireoidnim hormonom i vitaminom D, koji održavaju koncentraciju kalcija u krvi, stimuliraju reapsorpciju kalcija iz kosti, apsorpciju kalcija u crijevima i izlučivanje kalcija bubrezima. U toj regulaciji sudjeluje i kalcitonin, podrijetlom iz štitnjače, koji djeluje antagonistički na paratireoidni hormon. Mjerenje paratireoidnog hormona važno u diferencijalnoj dijagnostici hiperkalcijemije i hipokalcijemije, te za procjenu funkcije paratireoidne žlijezde. Za praćenje statusa kalcija u organizmu određuje se koncentracija ukupnog kalcija i koncentracija slobodnog (ioniziranog) kalcija. Cilj ovoga rada bio je utvrditi u kojoj mjeri operativni zahvat na štitnjači poremeti homeostazu kalcija u pacijenata koji su podvrgnuti totalnoj tireoidektomiji u odnosu na pacijente koji imaju ostale zahvate na štitnjači ili doštitnoj žlijezdi. Istraživanje je uključivalo 192 pacijenta kojima su uzeti uzorci krvi prije operativnog zahvata i 24 do 72 sati nakon operativnog zahvata. U uzorcima seruma izmjerene su vrijednosti ioniziranog kalcija na analizatoru Rapidpoint 400 i paratireoidnog hormona na automatskom analizatoru cobas e 411. Među operativnim zahvatima na štitnjači najučestalija je totalna tireoidektomija što se potvrdilo u periodu od 5 mjeseci istraživanja. Rezultati su pokazali da prije operativnih zahvata nije bilo razlike između medijana koncentracija PTH i iCa u ovisnosti o vrsti operacije. Nakon zahvata utvrđen je statistički značajan pad koncentracija za PTH i iCa za sve bolesnike, neovisno o vrsti zahvata i spolu (P<0,0001), a pad je značajno izraženiji u bolesnika kojima je odstranjena štitnjača (P ≤0,001). Žene i muškarci pokazuju jednake promjene i statistički se ne razlikuju. Između žena i muškaraca nema razlike u stupnju sniženja koncentracije iCa, odnosno oba spola imaju značajno veće razlike u koncentracijama kad su tireoidektomirani. Statistička značajnost slabije snage (P=0,042) uočena je kod žena u kojih tireoidektomija snizuje PTH prosječno -24% , a ostale operacije tek -4%. Sve skupine bolesnika ugrožene u postoperativnom tijeku privremene nefunkcionalnosti doštitne žlijezde, brzog pada koncentracije hormona PTH i kasnijeg razvoja hipokalcijemije.

Abstract (english)

Calcium homeostasis in human body is regulated by the parathyroid hormone (PTH) and vitamin D, which maintain the concentration of calcium in the blood, stimulate bone calcium reabsorption, calcium absorption in the intestine, and calcium excretion of the kidneys. Calcitonin is an antagonist of parathyroid hormone and it also participates in this regulation. Measurement of parathyroid hormone is important in differential diagnosis of hypercalciemia and hypocalciemia, and for evaluating the function of the parathyroid gland. To monitor the calcium status in the body, the concentration of total calcium and the concentration of free (ionized) calcium (iCa) are determined. The aim of this study was to determine the extent to which the operation of the thyroid gland disrupts calcium homeostasis in patients who undergo total thyroidectomy in relation to the patients who have other thyroid or paratyroid surgery. The study included 192 patients whose blood samples were collected prior to surgery and 24 to 72 hours after the operation. In serum samples were measured the concentrations of ionized calcium on the Rapidpoint 400 analyzer and parathyroid hormone on the cobas e 411 automated analyzer. Total thyroidectomy is the most common among surgical interventions on the thyroid gland, confirmed in a five month research period. The results show that there was no difference between the median concentration of PTH and iCa before the operation, depending on the type of surgery. A significant decrease in PTH and iCa concentrations was found after the procedure in all patients, irrespective of the type of procedure and sex (P <0.0001), and the decrease was significantly more pronounced in patients with removed thyroid gland (P ≤0.001). Women and men show the same changes and do not differ statistically. There is no difference in the lowering of iCa concentration between women and men, i.e. both sexes have significantly higher differences in concentrations when they are thyroid decompensated. A statistical significance of weaker power (P = 0.042) was observed in women, whose thyroid dehydration decreases PTH on average -24%, while other operations are only -4%. In the postoperative course all groups of patients are endangered by temporal dysfunction of the intestine, rapid decline in PTH hormone concentration and subsequent hypocalcemia development.

• Keywords: paratireoidni hormon; ionizirani kalcij; štitnjača
• Keywords (english): parathyroid hormone; ionized calcium; thyroid
• Language: croatian
• URN:NBN: urn:nbn:hr:163:429876
• Study programme: Title: Medical biochemistry; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: magistar/magistra medicinske biokemije (magistar/magistra medicinske biokemije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-12-13 16:55:00