Uso de los valores de hormona paratiroidea intranodular obtenidos por punción con aguja fina como factor predictivo de hipoparatiroidismo posoperatorio

Objetivo: Analisis de los valores de hormona paratiroidea (PTH) intranodular obtenidos por puncion con aguja fina como factor predictivo de hipoparatiroidismo posoperatorio. Metodo: De los 157 pacientes a los que se realizo la medicion de la PTH intranodular, se estudiaron 37 que fueron intervenidos quirurgicamente, estableciendo 15 variables para analizar: edad, sexo, tiempo de evolucion, tamano, cirugia de tiroides asociada, tratamiento preoperatorio con calcimimeticos, litiasis renal, densitometria osea, aclaramiento de creatinina, calcio y PTH preoperatorios, PTH determinada tras puncion con aguja fina, descenso de la PTH intraoperatoria, calcio posoperatorio y malignidad de la tumoracion. Estas se compararon con la prueba de ji al cuadrado o el test exacto de Fisher, siendo significativa una p 88 pg/dl, el calcio preoperatorio > 12 mg/dl, los valores de PTH intranodular > 2700 pg/dl, el descenso de la PTH intraoperatoria a < 15 pg/dl y el calcio posoperatorio < 8,5 mg/dl fueron variables independientes significativas en el analisis univariante (p < 0.05) para la prediccion del hipoparatiroidismo posoperatorio. Conclusiones: Los valores de PTH intranodular pueden predecir que pacientes tienen mayor riesgo de sufrir un hipoparatiroidismo posoperatorio. Este factor debe tenerse en cuenta durante el estudio y el seguimiento de los pacientes para identificar precozmente posibles complicaciones. Objective: To analize if parathyroid hormone (PTH) washout levels can be considered a predictive factor of postoperative hypoparathyroidism and determine its importance relative to other features already known as intraoperative PTH, Ca and PTH preoperative, and others. Method: Of the 157 patients to whom a fine needle aspiration (FNA) biopsy with intranodular parathyroid hormone level measurement was performed (washout PTH) 37 who underwent surgery were studied. 15 variables were taken into account when selecting patients for this study: age, gender, evolution length, size, associated thyroid surgery, preoperative treatment with calcimimetics, presence of renal lithiasis, bone densitometry alterations, creatine clearance, preoperative calcium and PTH levels, PTH scores obtained by fine needle aspiration, intraoperative PTH decrease, postoperative calcium levels and tumour malignancy. We compare the nominal values, using the Chi squared or the exact Fisher test, where p < 0.05 was considered statistically significant and perform a logistic regression analysis. Results: The use of calcimimetics prior to surgery, the preoperative PTH level above 88 pg/dl, the preoperative calcium above 12 mg/dl, washout PTH above 2700 pg/dl, intraoperative PTH level decrease below 15 pg/dl, and postoperative calcium levels under 8.5 mg/dl were all independently significant variables in the univariant analysis (p < 0.05) in order to establish an early postoperative hypoparathyroidism. The rest of the variables were not statistically significative. Conclusion: The PTH washout levels can predict the appearance of postoperative hypoparathyroidism. This factor must be taken into account during the study and follow-up to identify possible complications and establish an adequate treatment on time.