Hipocalcemia e hipoparatiroidismo post-tiroidectomía

Autores/as

  • Hermann Barquero Melchor Caja Costarricense del Seguro Social, Hospital México
  • María José Delgado Rodríguez Caja Costarricense del Seguro Social, Hospital San Juan de Dios
  • Josías Juantá Castro

DOI:

https://doi.org/10.51481/amc.v57i4.900

Palabras clave:

hipocalcemia, hipoparatiroidismo, cáncer de tiroides, tiroidectomía, Costa Rica

Resumen

Justificación: la hipocalcemia y el hipoparatiroidismo son complicaciones frecuentes tras la tiroidectomía. Sin embargo, su incidencia varía ampliamente en la bibliografía médica y sus factores de riesgo no están bien establecidos.

Métodos: a través de una recolección prospectiva de datos, se identificó 35 pacientes tiroidectomizados entre junio y noviembre de 2012. La hipocalcemia se definió como un valor de calcio sérico en el primer día postoperatorio, menor de 7,5 mEq/l, sin síntomas, o menor de 8,5 mEq/l, con síntomas o signos asociados con hipocalcemia. El hipoparatiroidismo se definió como un calcio sérico a los 12 meses de la operación menor de 8,5 mEq/l, y/o el requerimiento de calcio y vitamina D. Se extrajeron variables adicionales como la edad del paciente, sexo, antecedente de cirugía tiroidea previa, estancia posoperatoria y cirujano principal de la operación.

Resultados: catorce (42,4%) de los treinta y cinco pacientes sometidos a tiroidectomía desarrollaron hipocalcemia, y ocho (22,8%) sufrieron hipoparatiroidismo. En el procedimiento quirúrgico de tiroidectomía total, se presentó una mayor incidencia de hipocalcemia (50%) y de hipoparatiroidismo (28,6%) cuando se comparó con el procedimiento de tiroidectomía subtotal. Factores adicionales asociados significativamente con hipocalcemia e hipoparatiroidismo fueron el diagnóstico citológico prequirúrgico de malignidad (p = 0,014; p = 0,044), la linfadenectomía cervical (p = 0,024; p = 0,033) y un médico asistente especialista como cirujano principal (p = 0,030; p = 0,027). La hipocalcemia tras la tiroidectomía produjo 4,9 días más de estancia hospitalaria (8,0 vs 3,1 días; p = 0,018).

Conclusión: la hipocalcemia y el hipoparatiroidismo son complicaciones frecuentes de la tiroidectomía, particularmente tiroidectomía total por cáncer o con linfadenectomía cervical o realizada por un médico asistente.

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Publicado

2015-10-19 — Actualizado el 2015-10-19

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Cómo citar

Melchor, H. B., Rodríguez, M. J. D., & Castro, J. J. (2015). Hipocalcemia e hipoparatiroidismo post-tiroidectomía. Acta Médica Costarricense, 57(4), 184–189. https://doi.org/10.51481/amc.v57i4.900