Do Low Preoperative Vitamin D Levels Reduce the Accuracy of Quick Parathyroid Hormone in Predicting Postthyroidectomy Hypocalcemia?
Although some studies have suggested that low preoperative 25-hydroxyvitamin D (25-OHD) levels may increase the risk of hypocalcemia and decrease the accuracy of single quick parathyroid hormone in predicting hypocalcemia after total thyroidectomy, the literature remains scarce and inconsistent. Our study aimed to address these issues.
Of the 281 consecutive patients who underwent a total/completion total thyroidectomy, 244 (86.8 %) did not require any oral calcium and/or calcitriol supplements (group 1), while 37 (13.2 %) did (group 2) at hospital discharge. 25-OHD level was checked 1 day before surgery, and postoperative quick parathyroid hormone (PTH) was checked at skin closure (PTH-SC). Postoperative serum calcium was checked regularly. Hypocalcemia was defined by the presence of symptoms or adjusted calcium of <1.90 mmol/L. Significant factors for hypocalcemia were determined by univariate and multivariate analyses. The accuracy of PTH-SC in predicting hypocalcemia was measured by area under a receiver operating characteristic curve (AUC), and the AUC of PTH-SC was compared between patients with preoperative 25-OHD <15 and ≥15 ng/mL via bootstrapping.
Preoperative 25-OHD level was not significantly different between groups 1 and 2 (13.1 vs. 12.5 ng/mL, p = 0.175). After adjusting for other significant factors, PTH-SC (odds ratio 2.49, 95 % confidence interval 1.52–4.07, p < 0.001) and parathyroid autotransplantation (odds ratio 3.23, 95 % confidence interval 1.22–8.60, p = 0.019) were the two independent factors for hypocalcemia. The AUC of PTH-SC was similar between those with 25-OHD <15 and ≥15 ng/mL (0.880 vs. 0.850, p = 0.61)
Low 25-OHD was not a significant factor for hypocalcemia and did not lower the accuracy of quick PTH in predicting postthyroidectomy hypocalcemia.
- Lo, CY, Lam, KY (1998) Postoperative hypocalcemia in patients who did or did not undergo parathyroid autotransplantation during thyroidectomy: a comparative study. Surgery. 124: pp. 6-1081 CrossRef
- Wong, KP, Lang, BH (2011) Graves’ ophthalmopathy as an indication increased the risk of hypoparathyroidism after bilateral thyroidectomy. World J Surg. 35: pp. 8-2212 CrossRef
- Chia, SH, Weisman, RA, Tieu, D, Kelly, C, Dillmann, WH, Orloff, LA (2006) Prospective study of perioperative factors predicting hypocalcemia after thyroid and parathyroid surgery. Arch Otolaryngol Head Neck Surg. 132: pp. 5-41 CrossRef
- Lombardi, CP, Raffaelli, M, Princi, P (2004) Early prediction of postthyroidectomy hypocalcemia by one single iPTH measurement. Surgery. 136: pp. 41-1236 CrossRef
- Lombardi, CP, Raffaelli, M, Princi, P (2006) Parathyroid hormone levels 4 hours after surgery do not accurately predict post-thyroidectomy hypocalcemia. Surgery. 140: pp. 23-1016
- Lang, BH, Yih, PC, Ng, KK (2012) A prospective evaluation of quick intraoperative parathyroid hormone assay at the time of skin closure in predicting clinically relevant hypocalcemia after thyroidectomy. World J Surg. 36: pp. 6-1300
- Grodski, S, Serpell, J (2008) Evidence for the role of perioperative PTH measurement after total thyroidectomy as a predictor of hypocalcemia. World J Surg. 32: pp. 73-1367 CrossRef
- Barczyński, M, Cichoń, S, Konturek, A (2007) Which criterion of intraoperative iPTH assay is the most accurate in prediction of true serum calcium levels after thyroid surgery?. Langenbecks Arch Surg. 392: pp. 8-693
- Noordzij, JP, Lee, SL, Bernet, VJ (2007) Early prediction of hypocalcemia after thyroidectomy using parathyroid hormone: an analysis of pooled individual patient data from nine observational studies. J Am Coll Surg. 205: pp. 54-748 CrossRef
- Erbil, Y, Bozbora, A, Ozbey, N (2007) Predictive value of age and serum parathormone and vitamin D3 levels for postoperative hypocalcemia after total thyroidectomy for nontoxic multinodular goiter. Arch Surg. 142: pp. 7-1182 CrossRef
- Erbil, Y, Barbaros, U, Temel, B (2009) The impact of age, vitamin D(3) level, and incidental parathyroidectomy on postoperative hypocalcemia after total or near total thyroidectomy. Am J Surg. 197: pp. 46-439 CrossRef
- Kirkby-Bott, J, Markogiannakis, H, Skandarajah, A, Cowan, M, Fleming, B, Palazzo, F (2011) Preoperative vitamin D deficiency predicts postoperative hypocalcemia after total thyroidectomy. World J Surg. 35: pp. 30-324 CrossRef
- Sam, AH, Dhillo, WS, Donaldson, M, Meeran, K, Tolley, NS, Palazzo, FF (2011) Serum parathyroid hormone is not an accurate predictor of postthyroidectomy hypocalcemia in vitamin D-deficient patients: a pilot study. Clin Chem. 57: pp. 7-1206 CrossRef
- Lang, BH, Lo, CY (2005) Total thyroidectomy for multinodular goiter in the elderly. Am J Surg. 190: pp. 23-418 CrossRef
- Youden, WJ (1950) Index for rating diagnostic tests. Cancer. 3: pp. 5-32 CrossRef
- Lang, BH, Lo, CY (2010) Vitamin D3 deficiency is associated with late-onset hypocalcemia after minimally invasive parathyroidectomy in a vitamin D borderline area. World J Surg. 34: pp. 5-1350 CrossRef
- Yamashita, H, Murakami, T, Noguchi, S (1999) Postoperative tetany in Graves disease: important role of vitamin D metabolites. Ann Surg. 229: pp. 45-237 CrossRef
- Roh, JL, Park, CI (2006) Routine oral calcium and vitamin D supplements for prevention of hypocalcemia after total thyroidectomy. Am J Surg. 192: pp. 8-675 CrossRef
- Erbil, Y, Ozbey, NC, Sari, S (2011) Determinants of postoperative hypocalcemia in vitamin D-deficient Graves’ patients after total thyroidectomy. Am J Surg. 201: pp. 91-685 CrossRef
- Hallgrimsson, P, Nordenström, E, Almquist, M, Bergenfelz, AO (2012) Risk factors for medically treated hypocalcemia after surgery for Graves’ disease: a Swedish multicenter study of 1,157 patients. World J Surg. 36: pp. 42-1933 CrossRef
- Landry, CS, Grubbs, EG, Hernandez, M (2012) Predictable criteria for selective, rather than routine, calcium supplementation following thyroidectomy. Arch Surg. 147: pp. 44-338
- Lo, CY, Luk, JM, Tam, SC (2002) Applicability of intraoperative parathyroid hormone assay during thyroidectomy. Ann Surg. 236: pp. 9-564 CrossRef
- Promberger, R, Ott, J, Kober, F, Karik, M, Freissmuth, M, Hermann, M (2011) Normal parathyroid hormone levels do not exclude permanent hypoparathyroidism after thyroidectomy. Thyroid. 21: pp. 50-145 CrossRef
- Do Low Preoperative Vitamin D Levels Reduce the Accuracy of Quick Parathyroid Hormone in Predicting Postthyroidectomy Hypocalcemia?
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Annals of Surgical Oncology
Volume 20, Issue 3 , pp 739-745
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Division of Endocrine Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China
- 2. School of Public Health, The University of Hong Kong, Hong Kong SAR, China