{"id":494,"date":"2019-07-05T09:31:05","date_gmt":"2019-07-05T09:31:05","guid":{"rendered":"https:\/\/www.barnaclinic.com\/blog\/cirugia-de-tiroides\/ca\/?p=494"},"modified":"2019-07-05T09:31:05","modified_gmt":"2019-07-05T09:31:05","slug":"hipocalcemia","status":"publish","type":"post","link":"https:\/\/www.barnaclinic.com\/blog\/cirugia-de-tiroides\/ca\/hipocalcemia\/","title":{"rendered":"Hipocalc\u00e8mia i hipoparatiro\u00efdisme despr\u00e9s d’una cirurgia de c\u00e0ncer de tiroide"},"content":{"rendered":"

La\u00a0hipocalc\u00e8mia<\/strong>\u00a0\u00e9s la complicaci\u00f3 m\u00e9s freq\u00fcent despr\u00e9s d’una\u00a0<\/a>tiroidectomia<\/a> per c\u00e0ncer.<\/strong><\/span>\u00a0Una de les principals\u00a0causes d’hipocalc\u00e8mia<\/strong>\u00a0\u00e9s la disminuci\u00f3 de la PTH<\/a> (parathormona, paratirina)<\/em>\u00a0per desvascularitzaci\u00f3 i\/ o extirpaci\u00f3 inadvertida de les\u00a0gl\u00e0ndules paratiroides<\/strong><\/a>\u00a0durant la\u00a0cirurgia de tiroide<\/strong><\/a>\u00a0.<\/span>\u00a0Per evitar la seva aparici\u00f3 per aquest motiu, s’ha intentat posar una soluci\u00f3:\u00a0l’autotrasplantament de paratiroide\u00a0<\/strong>no viables in situ o clarament desvascularizadas.<\/span>\u00a0Aquesta t\u00e8cnica \u00e9s discutible i no s’ha pogut demostrar que redueixi l’hipoparatiro\u00efdisme<\/strong>\u00a0postoperatori,<\/strong>\u00a0o que tingui cap benefici.<\/span><\/p>\n

<\/p>\n

\n
\n

T’INTERESSA…<\/h4>\n

–\u00a0Gl\u00e1ndulas paratiroides \u00bfQu\u00e9 son, qu\u00e9 funci\u00f3n tienen y c\u00f3mo pueden enfermar?<\/a><\/h4>\n

–\u00a0\u00bfCu\u00e1les son las complicaciones m\u00e1s frecuentes de la cirug\u00eda de tiroides?<\/a><\/h4>\n<\/blockquote>\n<\/div>\n

S\u00cdMPTOMES D’HIPOCALC\u00c8MIA<\/span><\/h2>\n

En la majoria dels casos,\u00a0l’hipocalc\u00e8mia no presenta s\u00edmptomes,<\/strong>\u00a0a causa que aquesta es detecta abans que la calc\u00e8mia descendeixi per sota de nivells que puguin causar s\u00edmptomes aguts.<\/span>\u00a0No obstant aix\u00f2, un dels\u00a0principals s\u00edmptomes d’hipocalc\u00e8mia postoperat\u00f2ria \u00e9s la tet\u00e0nia<\/strong>\u00a0(contraccions musculars involunt\u00e0ries), que sol anar precedida\u00a0de parest\u00e8sies<\/strong>\u00a0i\u00a0formigueig sim\u00e8trics en bra\u00e7os i cames.<\/strong><\/span>\u00a0A m\u00e9s, es poden produir tamb\u00e9 s\u00edmptomes semblants als de\u00a0l’ansietat<\/a>,<\/strong>\u00a0com la hiperventilaci\u00f3.<\/span><\/p>\n

\n

\"Dr.<\/a><\/strong><\/em><\/h4>\n

“El s\u00edmptoma t\u00edpic de hipocalc\u00e8mia \u00e9s la tet\u00e0nia<\/strong>(contraccions musculars involunt\u00e0ries), precedida\u00a0d’parest\u00e8sies<\/strong>\u00a0i\u00a0formigueig en bra\u00e7os i cames”<\/strong><\/span><\/h4>\n

Dr. Oscar Vidal<\/a><\/p><\/blockquote>\n

TRACTAMENT DE LA HIPOCALC\u00c8MIA POSTOPERAT\u00d2RIA<\/span><\/h2>\n

En general, no hi ha consens sobre com ha de ser el maneig i el\u00a0tractament de la hipocalc\u00e8mia postoperat\u00f2ria.<\/strong><\/span>\u00a0S\u00f3n m\u00faltiples els protocols i no hi ha estudis prospectius que avalin una estrat\u00e8gia o una altra.<\/span>\u00a0En qualsevol cas, s’ha de detectar preco\u00e7ment per evitar que apareguin els s\u00edmptomes (amb una simple anal\u00edtica sangu\u00ednia).<\/span>\u00a0D’altra banda, s’ha d’administrar una suplementaci\u00f3 amb calci despr\u00e9s de la\u00a0cirurgia de\u00a0<\/strong>c\u00e0ncer de tiroide<\/strong><\/a>, que es mantindr\u00e0 o no, sobre la base de la calc\u00e8mia realitzada en el postoperatori (generalment a les 24 hores).<\/span><\/p>\n

A QUI POT AFECTAR?<\/span><\/h2>\n

En la literatura hi ha dades molt heterogenis;<\/span>\u00a0si b\u00e9 podem considerar que entre el 30-50% dels pacients sotmesos a\u00a0tiroidectom\u00eda total,<\/strong>\u00a0per\u00a0c\u00e0ncer de tiroide<\/strong><\/a>\u00a0o per altres\u00a0malalties de la tiroide<\/strong><\/a>\u00a0, desenvolupar\u00e0\u00a0hipocalc\u00e8mia postoperat\u00f2ria<\/strong>\u00a0(Ca <8mg \/ dl) no greu.<\/span><\/p>\n

<\/h2>\n
\n

\"Dr.<\/a><\/strong><\/em><\/h4>\n

“Entre el 30-50% dels pacients sotmesos a\u00a0tiroidectom\u00eda total<\/strong>\u00a0desenvolupar\u00e0 hipocalc\u00e8mia postoperat\u00f2ria”<\/span><\/h4>\n

Dr. Oscar Vidal<\/a><\/p><\/blockquote>\n

\n
\n

T’INTERESSA…<\/h4>\n

–\u00a0Complicaciones m\u00e1s frecuentes de la cirug\u00eda de tiroides<\/a><\/h4>\n<\/blockquote>\n<\/div>\n

M\u00c9S EXPERI\u00c8NCIA DEL CENTRE I DEL DOCTOR, MENYS HIPOCALC\u00c8MIA<\/span><\/h2>\n

En hospitals de refer\u00e8ncia, en mans d’un\u00a0cirurgi\u00e0 expert en cirurgia de tiroides<\/strong><\/a>, la taxa\u00a0d’hipocalc\u00e8mia<\/strong>\u00a0i la durada de la mateixa \u00e9s menor.<\/span>\u00a0Com ens estem referint a pacients amb\u00a0c\u00e0ncer de tiroide<\/strong><\/a>, que poden requerir un\u00a0buidament ganglionar central<\/a>, cal subratllar que:\u00a0els ganglis a extirpar<\/a>\u00a0es troben propers a les\u00a0gl\u00e0ndules paratiroidees<\/strong><\/a>\u00a0i poden presentar una mida i, de vegades, un aspecte similar, que pot confondre al cirurgi\u00e0.<\/span>\u00a0Per aquest motiu, a m\u00e9s experi\u00e8ncia, menys\u00a0hipoparatiro\u00efdisme postoperatiri<\/strong>\u00a0i menys\u00a0problemes amb els nivells de calci.<\/strong><\/span><\/p>\n

\"Dr.<\/a><\/strong><\/em><\/h4>\n

“En hospitals de refer\u00e8ncia, en mans d’un\u00a0cirurgi\u00e0 expert en cirurgia de tiroides<\/strong><\/a>, la taxa\u00a0d’hipocalc\u00e8mia<\/strong>\u00a0i la durada de la mateixa \u00e9s menor”<\/h4>\n

Dr. Oscar Vidal<\/a><\/p>\n

QUANT DURA EL HIPOPARATIRO\u00cfDISME POSTOPERATORI?<\/span><\/h2>\n

En la majoria de casos, l’hipoparatiro\u00efdisme postoperatori<\/strong>\u00a0(principal\u00a0causa de baixos nivells de calci<\/strong>)\u00a0\u00e9s transitori i millorar\u00e0 als 3-6 mesos despr\u00e9s de la\u00a0cirurgia de tiroide<\/strong><\/a>.<\/span>\u00a0Si el pacient persisteix m\u00e9s d’un any amb\u00a0hipocalc\u00e8mia<\/strong>\u00a0i amb la necessitat de tractament substitutiu, es pot considerar un\u00a0hipoparatiro\u00efdisme permanent.<\/strong><\/span><\/p>\n

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\n

<\/p>\n

VOL\u00a0CONTACTAR\u00a0AMB EL DR. OSCAR VIDAL?<\/span><\/h1>\n

DEMANAR CITA<\/a><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

La\u00a0hipocalc\u00e8mia\u00a0\u00e9s la complicaci\u00f3 m\u00e9s freq\u00fcent despr\u00e9s d’una\u00a0tiroidectomia per c\u00e0ncer.\u00a0Una de les principals\u00a0causes d’hipocalc\u00e8mia\u00a0\u00e9s la disminuci\u00f3 de la PTH (parathormona, paratirina)\u00a0per desvascularitzaci\u00f3 i\/ o extirpaci\u00f3 inadvertida de les\u00a0gl\u00e0ndules paratiroides\u00a0durant la\u00a0cirurgia de tiroide\u00a0.\u00a0Per evitar la seva aparici\u00f3 per aquest motiu, s’ha intentat posar una soluci\u00f3:\u00a0l’autotrasplantament de paratiroide\u00a0no viables in situ o clarament desvascularizadas.\u00a0Aquesta t\u00e8cnica \u00e9s discutible i […]<\/p>\n","protected":false},"author":2,"featured_media":487,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[87,88,94],"tags":[178,133,166,108,177,80,136,35],"yoast_head":"\nHipocalc\u00e8mia i hipoparatiro\u00efdisme despr\u00e9s de cirurgia de c\u00e0ncer de tiroide<\/title>\n<meta name=\"description\" content=\"L'hipocalc\u00e8mia \u00e9s la complicaci\u00f3 m\u00e9s freq\u00fcent despr\u00e9s d'una cirurgia de tiroide per c\u00e0ncer. 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