Abstract
The relationship between preoperative vitamin D deficiency and postoperative hypocalcemia in cases of total thyroidectomy (TT) is a matter of controversy and may vary according to geographical scenarios and populations. The objective here was to evaluate whether preoperative vitamin D deficiency was associated with postoperative symptomatic hypocalcemia in a population in South America. Retrospective cohort study on data from all patients undergoing total thyroidectomy, with or without central compartment lymph node dissection, from January 2014 to December 2017, at the A. C. Camargo Cancer Center. Patients with benign thyroid disease (Graves' disease, multinodular goiter or hyperthyroidism) or thyroid cancer who underwent primary total thyroidectomy with or without central compartment lymph node dissection were included. The exclusion criteria were simultaneous parathyroidectomy and conditions that could affect serum calcium levels. The data collected included patient demographics, thyroid pathology, extent of the surgical procedure and complications. Information on preoperative and postoperative calcium, parathyroid hormone (PTH) and vitamin D levels were retrieved from the medical records. 1,347 patients were assessed and postoperative hypocalcemia was diagnosed in 284 patients (21%). The vitamin D levels were considered deficient in 243 patients (18%). Postoperative hypocalcemia was diagnosed in 357 patients (31.5%). Multivariate analysis showed that central compartment dissection and preoperative total calcium and deficient vitamin D levels were significant risk factors for postoperative hypocalcemia. Deficient preoperative vitamin D levels were a significant risk factor for postoperative hypocalcemia. Preoperative oral supplementation should be considered, to minimize this risk.
Highlights
Techniques for thyroidectomy have evolved remarkably over the past 150 years
Information on preoperative and postoperative calcium, parathyroid hormone (PTH) and vitamin D levels were retrieved from the medical records
The five patients who had preoperative PTH levels above the reference value were not excluded from the analysis because they did not have the diagnosis of primary hyperparathyroidism, given that their serum total calcium levels were at the lower limit of normality
Summary
Techniques for thyroidectomy have evolved remarkably over the past 150 years. This is currently considered to be a very safe operation with favorable results when performed by experienced surgeons.[1]. The established risk factors for hypoparathyroidism after total thyroidectomy are advanced age, female sex, size of the thyroid gland, substernal goiter, Graves’ disease, surgical technique (de-vascularization, excision or other inadvertent damage of the parathyroid glands), central compartment dissection, reoperation, less experienced surgeon and low 25-hydroxyvitamin D serum levels in the preoperative period.[9,10,11,12,13,14,15,16,17,18]. METHODS: Patients with benign thyroid disease (Graves’ disease, multinodular goiter or hyperthyroidism) or thyroid cancer who underwent primary total thyroidectomy with or without central compartment lymph node dissection were included. Multivariate analysis showed that central compartment dissection and preoperative total calcium and deficient vitamin D levels were significant risk factors for postoperative hypocalcemia. Preoperative oral supplementation should be considered, to minimize this risk
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