Abstract
Postoperative hypoparathyroidism is a common complication of total or completion thyroidectomy. The association between preoperative vitamin D deficiency (VDD) and the development of more severe postoperative hypocalcemia is still unclear. Objectives. To evaluate the effect of preoperative VDD on severity of hypocalcemia in patients with hypoparathyroidism following thyroidectomy. Methods. Patients who developed acute hypoparathyroidism after total or completion thyroidectomy, defined as postoperative parathyroid hormone (PTH) level <15 pg/mL and albumin-adjusted calcium level <8.6 mg/dL, were prospectively recruited. Patients were divided into two groups according to their preoperative vitamin D status (VDD group: 25-hydroxyvitamin D (25(OH)D) level <20 ng/mL; non-VDD group: 25(OH) level ≥20 ng/mL). The primary outcome was severity of hypocalcemia in postoperative hypoparathyroidism. Significant hypocalcemia was defined as calcium level ≤7.5 mg/dL. Results. Forty-three patients (21 VDD, 22 non-VDD) were enrolled. Serum total albumin-adjusted calcium level was significantly lower in the VDD group (7.71 ± 0.5 vs. 8.16 ± 0.4 mg/dL, p < 0.01), and the incidence of symptomatic hypocalcemia was significantly higher in the VDD group (43% vs. 9%, p=0.01). The median maximal daily supplementary dose of elemental calcium was significantly higher in the VDD group (2,400 vs. 1,500 mg/day, p=0.02). Length of hospital stay was nonsignificantly longer in the VDD group (p=0.06). Preoperative vitamin D level <19.6 ng/mL could predict significant and symptomatic hypocalcemia in postoperative hypoparathyroidism with sensitivity of 90% and 82% and specificity of 70% and 69%, respectively. Conclusion. VDD is an independent risk factor for both significant and symptomatic hypocalcemia in hypoparathyroidism patients after thyroid surgery.
Highlights
IntroductionPostoperative hypocalcemia is a common complication of total or completion thyroidectomy [1, 2]. e prevalence of this condition was reported to be 10% to 50% and 0.5% to 4.4% for transient and permanent hypocalcemia, respectively [3, 4]. e major cause of hypocalcemia after thyroid surgery is acute hypoparathyroidism resulting from injury, devascularization, or inadvertent removal of the parathyroid glands during thyroidectomy [5, 6]. is complication can cause morbidity, including symptomatic hypocalcemia, requirement for postoperative calcium and vitamin D supplementation, and longer length of hospital stay.Vitamin D deficiency (VDD), which is usually defined as serum 25-hydroxyvitamin D [25(OH)D] levels less than 20 ng/mL [7], is a global health problem
E serum albumin-adjusted calcium level which was measured at the first outpatient visit, 1–2 weeks following hospital discharge, was not different between Vitamin D deficiency (VDD) group and non-VDD group (9.07 vs. 8.92 mg/dL, p 0.59)
Data are presented as mean ± standard deviation (SD), number and percentage, or median and interquartile range (IQR)
Summary
Postoperative hypocalcemia is a common complication of total or completion thyroidectomy [1, 2]. e prevalence of this condition was reported to be 10% to 50% and 0.5% to 4.4% for transient and permanent hypocalcemia, respectively [3, 4]. e major cause of hypocalcemia after thyroid surgery is acute hypoparathyroidism resulting from injury, devascularization, or inadvertent removal of the parathyroid glands during thyroidectomy [5, 6]. is complication can cause morbidity, including symptomatic hypocalcemia, requirement for postoperative calcium and vitamin D supplementation, and longer length of hospital stay.Vitamin D deficiency (VDD), which is usually defined as serum 25-hydroxyvitamin D [25(OH)D] levels less than 20 ng/mL [7], is a global health problem. PTH is a major regulator of renal 1α-hydroxylase (CYP27B1) activity, thereby increasing the level of active metabolites of vitamin D (1,25-dihydroxyvitamin D; calcitriol) in the circulation; its absence, as in hypoparathyroidism, results in low serum calcium and manifests itself as symptomatic hypocalcemia [10]. Previous studies hypothesized that patients with postoperative hypoparathyroidism whose preoperative vitamin D level was low were at increased risk for lower serum calcium levels and symptomatic hypocalcemia due to the loss of compensatory role of PTH [11, 12]. Other studies have refuted this correlation [17,18,19] Both preoperative 25(OH)D level and postoperative PTH level have been reported as independent predictors for postthyroidectomy hypocalcemia. Based on these diverse results, we aimed to accurately investigate the role of low 25(OH)D level in developing hypocalcemia by eliminating PTH level as a confounder
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