Preoperative Vitamin D Levels as a Predictor of Transient Hypocalcemia and Hypoparathyroidism After Parathyroidectomy

Ilknur Ozturk Unsal,Davut Sakiz,Murat Calapkulu,Sema Hepsen,Erman Cakal,Muhammed Erkam Sencar,Mustafa Ozbek

doi:10.1038/s41598-020-66889-8

Abstract

Hypocalcemia is a common problem after parathyroidectomy and/or thyroidectomy. The complication may be transient or permanent. Most cases occur as a result of removal of the parathyroid glands or damage to the glands during neck surgery. The purpose of this study was to evaluate the effect of preoperative vitamin D deficiency in predicting transient hypocalcemia and hypoparathyroidism after parathyroidectomy.Retrospective evaluation was made of 180 patients with primary hyperparathyroidism in respect of serum 25(OH)D, calcium and parathyroid hormone before and after parathyroidectomy. Transient hypocalcemia was defined as corrected calcium ≤ 8.4 mg/dL, and these cases were then evaluated for preoperative 25(OH)D values. Transient hypoparathyroidism has been described as low PTH level immediately after surgery before beginning any supplementation. Permanent hypoparathyroidism is accepted as the need for medical treatment is necessary over 12 months.Both transient hypocalcemia and hypoparathyroidism developed at statistically significantly higher rates in patients with preoperative vitamin D deficiency and vitamin D insufficiency.Vitamin D deficiency is an independent contributor to transient hypocalcemia and hypoparathyroidism following parathyroidectomy.

Highlights

Surgery is always an appropriate option for individuals with PHPT and operative management is more effective and less costly than either long-term observation or medical treatment
256 patients with primary hyperparathyroidism were enrolled in the study, and after the exclusion of 76 patients for various reasons (Fig. 1), and the study was continued with 180 patients
At the end of the study, 37% of patients were determined with transient hypocalcemia and 24% with transient hypoparathyroidism (Figs. 3 and 4)

Summary

Introduction

Surgery is always an appropriate option for individuals with PHPT and operative management is more effective and less costly than either long-term observation or medical treatment. Nephrolithiasis incidence decreases, the bone mass densities of the lumbar spine and femoral neck increase compared to preoperative values, and fractures frequency decrease[12]. Hypocalcemia is a common problem after parathyroidectomy and/or thyroidectomy. Gambardella et al reported transient hypoparathroidism rates of 11.4% in total thyroidectomy vs 21.4% in total thyroidectomy with prophylactic central neck dissection and permanent hypoparathyroidism rates of 1.5% in total thyroidectomy vs 6.4% in total thyroidectomy with prophylactic central neck dissection[13]. There are no specific data for the prediction and management of hypocalcemia in patients with parathyroidectomy. The hypothesis of the study was that preoperative vitamin D deficiency indicates higher risk for postoperative transient hypoparathyroidism and hypocalcemia in patients following parathyroidectomy

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Conclusion