Analysis Of Risk Factors For Graves Disease Complicated With Hypercalcemia

Objective:To explore the risk factors of Graves disease complicated with hypercalcemia by analyzing the clinical data of Graves disease patients,in order to identify Graves disease patients who are prone to hypercalcemia,conduct early monitoring,take early intervention measures,actively treat hyperthyroidism,reduce the incidence of hypercalcemia and reduce the harm caused by hypercalcemia.Methods:The clinical data of 468 Graves disease patients who were admitted to the Endocrine and Metabolic Disease Center of Linyi People's Hospital from January 2017 to April 2018 were selected.Collect patient's gender,age,serum free thyroxine?FT₄?,serum free triiodothyronine?FT₃?,thyroid stimulating hormone?TSH?,thyrotropin receptor antibody?TRAb?,thyroid peroxidase antibody?TPOAb?,intact parathyroid hormone?iPTH?,25-hydroxyvitamin D?25?OH?D?,blood calcium,blood phosphorus,blood magnesium,total protein?TP?,globulin?GLO?,albumin?ALB?,alkaline phosphatase?ALP?,etc.The serum calcium concentration of Graves disease patients whose serum albumin value was lower than 40 g/L was corrected by serum albumin correction formula and then grouped according to the normal blood calcium concentration reference range of2.03².54 mmol/L detected by the Clinical Laboratory of Linyi People's Hospital.Divided into high calcium group?>2.54 mmol/L?and non-high calcium group??2.54mmo/L?.To compare the changes of serum calcium concentration and the incidence of hypercalcemia before and after correction.The difference between gender,age,FT₃,FT₄,TSH,TPOAb,TRAb,iPTH,25?OH?D in the two groups was statistically analyzed by?²test and t-test.Multivariate logistic regression analysis was then performed on factors that may be meaningful to screen for independent risk factors for Graves disease complicated with hypercalcemia.The ROC curve was drawn to verify the accuracy of predictors.According to whether the age of Graves disease patients is greater than 60 years old,divided into elderly group?>60 years old?and non-elderly group??60 years old?,Pearson correlation analysis was performed to compare the correlation between serum calcium concentration and thyroid hormone in different age groups.Results:In this study,468 Graves disease patients with 270 patients with serum albumin value were less than 40 g/L?57.69%?,53 patients with hypercalcemia before the correction,the probability of hypercalcemia was 11.32%.After adjustment,83 patients developed hypercalcemia,and the incidence increased to 17.74%.The?² test showed a statistically significant difference in the incidence of hypercalcemia before and after correction??²=277.24,P<0.05?.The results of t-test showed that FT₃,FT₄,iPTH,serum phosphorus and blood magnesium were associated with hypercalcemia?P<0.05?.Among them,FT₃,FT₄ and serum phosphorus levels in the high calcium group were higher than those in the non-high calcium group,iPTH,blood magnesium levels were lower than the non-high calcium group.There were no significant differences in gender,age,TSH,TRAb,TPOAb,25?OH?D,TP,GLO,ALB,and ALP between the two groups after adjustment for serum calcium?P>0.05?.Pearson correlation analysis showed that there was a positive linear correlation between serum calcium concentration and FT₃ and FT₄levels?r=0.305,0.308,P<0.001?.There was a weak correlation between serum calcium concentration and FT₃ and FT₄ levels in non-elderly groups?r=0.279,0.289,P<0.001?;however,there was a moderate correlation between serum calcium concentration and FT₃and FT₄ levels in the elderly group?r=0.499,0.466,P<0.001?.It could be seen that the positive linear correlation between blood calcium concentration and FT₃ and FT₄ levels were more obvious in the elderly group.Multivariate logistic regression analysis showed that FT₃,iPTH,serum phosphorus,and magnesium were associated with hypercalcemia,FT₃?OR=1.084,95%CI:1.033¹.137,P=0.001?,iPTH?OR=0.965,95%CI:0.948⁰.983,P<0.001?,blood phosphorus?OR=6.217,95%CI:1.847²0.631,P=0.003?,blood magnesium?OR=0.015,95%CI:0.000⁰.768,P=0.036?.Among them,FT₃ was an independent risk factor for Graves with hypercalcemia.The optimal cut-off value of FT₃for predicting hypercalcemia was 24.345 pmol/L,and the sensitivity and specificity were79.5%and 51.4%?AUC:0.688;95%CI:0.632⁰.745,P<0.001?.Conclusion:FT₃ is an independent risk factor for Graves disease complicated with hypercalcemia,and the patient's age,gender,FT₄,TSH,TRAb,TPOAb,iPTH,25?OH?D,blood phosphorus,blood magnesium,TP,GLO,ALB,ALP are not risk factors.Therefore,the key to the treatment of hyperthyroidism is to actively treat the primary disease.The optimal cut-off value of FT₃ for predicting hypercalcemia is 24.345 pmol/L.The higher the concentration,the more likely it is to have hypercalcemia.When the concentration of FT₃ exceeds 24.345 pmol/L,attention should be paid to monitoring blood calcium and actively treating hyperthyroidism to prevent the occurrence of hypercalcemia.