Can preoperative 25-hydroxyvitamin D levels predict transient hypocalcemia after total thyroidectomy?

Alberto Maria Saibene,Paolo Lozza,Cecilia Rosso,Simone De Leo,Giovanni Felisati,Carlotta Pipolo,Mario Gennaro Cozzolino,Loredana De Pasquale

doi:10.1007/s13304-021-01158-5

Alberto Maria Saibene, Paolo Lozza + Show 6 more

Open Access

https://doi.org/10.1007/s13304-021-01158-5

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Abstract

Transient postoperative hypocalcemia is a common complication after total thyroidectomy. Evidence on contributing metabolic factors is contradictory. Our work aims to define the role of preoperative 25-hydroxyvitaminD levels in developing transient postoperative hypocalcemia. 183 consecutive patients who underwent total thyroidectomy at our institution (May 2017–December 2019) were included in the retrospective study. We reported gender, age, estimated glomerular filtration rate, creatinine, preoperative 25-hydroxyvitaminD, serum pre- and postoperative calcium, pre- and postoperative PTH levels and transient postoperative hypocalcemia occurrences. We compared variables both among patients with and without transient postoperative hypocalcemia and between patients with different 25-hydroxyvitaminD levels (< 10 ng/ml deficitary; 11–30 ng/ml insufficient; > 30 ng/ml, normal). A binomial logistic regression model evaluating the risk for transient postoperative hypocalcemia was elaborated. Patients with transient postoperative hypocalcemia had lower levels of postoperative PTH (p < 0.001) and more frequently normal or deficitary 25-hydroxyvitaminD levels (p = 0.05). When comparing patients according to their 25-hydroxyvitaminD levels, insufficiency was associated with a lower rate of transient postoperative hypocalcemia (p = 0.05); deficiency was associated with higher preoperative PTH (p = 0.021), postoperative PTH (p = 0.043) and estimated glomerular filtration rate (p = 0.031) and lower serum creatinine (p = 0.014). In the regression model higher preoperative PTH (OR = 1.011, p = 0.041) and 25-hydroxyvitaminD deficiency (OR = 0.343, p = 0.011) significantly predicted transient postoperative hypocalcemia. Data analysis revealed a correlation between transient postoperative hypocalcemia and 25-hydroxyvitaminD levels: our work points towards the possibility to stratify the risk of transient postoperative hypocalcemia according to patients’ preoperative 25-hydroxyvitaminD status.

Highlights

Postoperative hypocalcemia and hypoparathyroidism represent one of the most common complications of total thyroidectomy (TT) [1]
Our work aims at evaluating the correlation between pre-operative factors and Transient postoperative hypocalcemia (TPH) risk in a retrospective cohort of patients undergoing TT at a single institution
This study was conceived as a retrospective cohort study on all consecutive patients who underwent total thyroidectomy at a single institution (Santi Paolo e Carlo Hospital, Milan, Italy) from May 2017 to December 2019

Summary

Introduction

Postoperative hypocalcemia and hypoparathyroidism represent one of the most common complications of total thyroidectomy (TT) [1]. Transient postoperative hypocalcemia (TPH) usually leads to longer hospitalization and/or recovery time, additional biochemical tests, potential symptomatic deficiencies and complications, with a direct increase of healthcare costs and disease burden [1]. Parathyroid glands injury or accidental removal during TT is another established critical risk factor for TPH [4, 5]. Since these factors cannot explain each clinical scenario, other factors have been alternatively analyzed to assess their relationship with TPH. The American Thyroid Association indicates low postoperative PTH as a predictor of post-total thyroidectomy hypocalcemia [8]

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