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Vitamin D level is not a predictor of hypocalcemia after total thyroidectomy

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Abstract

Purpose

As the incidence of thyroid cancer has increased, hypocalcemia, a common complication of thyroid surgery, has become a serious problem. However, no definite predictor of postoperative hypocalcemia is known. In this study, our purpose was to investigate the potential role of vitamin D as a predictor of postoperative hypocalcemia.

Methods

A prospective observational study was performed on patients who underwent total thyroidectomy for thyroid cancer performed by a single experienced surgeon between October 2013 and September 2014.

Measurements

Their serum 25-OH vitamin D levels were measured preoperatively. On the day after surgery, serum calcium and intact parathyroid hormone levels were measured, and symptoms of hypocalcemia were recorded.

Results

Of the 134 patients, laboratory and symptomatic hypocalcemia developed in 52 patients (39 %) and 25 patients (19 %), on the day after surgery. The preoperative vitamin D level was 16.5 ± 9.2 ng/mL, and this value did not differ according to laboratory or symptomatic hypocalcemia (p = 0.94). The incidence of laboratory or symptomatic hypocalcemia did not differ according to vitamin D deficiency. Only incidental parathyroidectomy was associated with symptomatic hypocalcemia (p = 0.03).

Conclusions

Vitamin D level is not a predictor of hypocalcemia after total thyroidectomy for thyroid cancer. Thus, routine preoperative screening for vitamin D is not recommended.

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References

  1. Davies L, Welch HG (2006) Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA 295:2164–2167

    Article  CAS  PubMed  Google Scholar 

  2. Al-Suliman NN, Ryttov NF, Qvist N et al (1997) Experience in a specialist thyroid surgery unit: a demographic study, surgical complications, and outcome. Eur J Surg 163:13–20

    CAS  PubMed  Google Scholar 

  3. Pattou F, Combemale F, Fabre S et al (1998) Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg 22:718–724

    Article  CAS  PubMed  Google Scholar 

  4. Reeve T, Thompson NW (2000) Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient. World J Surg 24:971–975

    Article  CAS  PubMed  Google Scholar 

  5. Adams J, Andersen P, Everts E et al (1998) Early postoperative calcium levels as predictors of hypocalcemia. Laryngoscope 108:1829–1831

    Article  CAS  PubMed  Google Scholar 

  6. Bentrem DJ, Rademaker A, Angelos P (2001) Evaluation of serum calcium levels in predicting hypoparathyroidism after total/near-total thyroidectomy or parathyroidectomy. Am Surg 67:249–251, discussion 251–242

    CAS  PubMed  Google Scholar 

  7. Moore C, Lampe H, Agrawal S (2001) Predictability of hypocalcemia using early postoperative serum calcium levels. J Otolaryngol 30:266–270

    Article  CAS  PubMed  Google Scholar 

  8. Quiros RM, Pesce CE, Wilhelm SM et al (2005) Intraoperative parathyroid hormone levels in thyroid surgery are predictive of postoperative hypoparathyroidism and need for vitamin D supplementation. Am J Surg 189:306–309

    Article  CAS  PubMed  Google Scholar 

  9. Moore FD Jr (1994) Oral calcium supplements to enhance early hospital discharge after bilateral surgical treatment of the thyroid gland or exploration of the parathyroid glands. J Am Coll Surg 178:11–16

    PubMed  Google Scholar 

  10. Bellantone R, Lombardi CP, Raffaelli M et al (2002) Is routine supplementation therapy (calcium and vitamin D) useful after total thyroidectomy? Surgery 132:1109–1112, discussion 1112–1103

    Article  PubMed  Google Scholar 

  11. Kurukahvecioglu O, Karamercan A, Akin M et al (2007) Potential benefit of oral calcium/vitamin D administration for prevention of symptomatic hypocalcemia after total thyroidectomy. Endocr Regul 41:35–39

    CAS  PubMed  Google Scholar 

  12. Roh JL, Park CI (2006) Routine oral calcium and vitamin D supplements for prevention of hypocalcemia after total thyroidectomy. Am J Surg 192:675–678

    Article  CAS  PubMed  Google Scholar 

  13. Roh JL, Park JY, Park CI (2009) Prevention of postoperative hypocalcemia with routine oral calcium and vitamin D supplements in patients with differentiated papillary thyroid carcinoma undergoing total thyroidectomy plus central neck dissection. Cancer 115:251–258

    Article  CAS  PubMed  Google Scholar 

  14. Yamashita H, Noguchi S, Murakami T et al (2001) Predictive risk factors for postoperative tetany in female patients with Graves' disease. J Am Coll Surg 192:465–468

    Article  CAS  PubMed  Google Scholar 

  15. Erbil Y, Barbaros U, Temel B et al (2009) The impact of age, vitamin D(3) level, and incidental parathyroidectomy on postoperative hypocalcemia after total or near total thyroidectomy. Am J Surg 197:439–446

    Article  CAS  PubMed  Google Scholar 

  16. Kirkby-Bott J, Markogiannakis H, Skandarajah A et al (2011) Preoperative vitamin D deficiency predicts postoperative hypocalcemia after total thyroidectomy. World J Surg 35:324–330

    Article  PubMed  Google Scholar 

  17. Holick MF (2007) Vitamin D deficiency. N Engl J Med 357:266–281

    Article  CAS  PubMed  Google Scholar 

  18. Valcour A, Blocki F, Hawkins DM et al (2012) Effects of age and serum 25-OH-vitamin D on serum parathyroid hormone levels. J Clin Endocrinol Metab 97:3989–3995

    Article  CAS  PubMed  Google Scholar 

  19. Garg MK, Tandon N, Marwaha RK et al (2014) The relationship between serum 25-hydroxy vitamin D, parathormone and bone mineral density in Indian population. Clin Endocrinol (Oxf) 80:41–46

    Article  CAS  Google Scholar 

  20. Lin Y, Ross HL, Raeburn CD et al (2012) Vitamin D deficiency does not increase the rate of postoperative hypocalcemia after thyroidectomy. Am J Surg 204:888–893, discussion 893–894

  21. Lang BH, Wong KP, Cheung CY et al (2013) Does preoperative 25-hydroxyvitamin D status significantly affect the calcium kinetics after total thyroidectomy? World J Surg 37:1592–1598

    Article  PubMed  Google Scholar 

  22. Griffin TP, Murphy MS, Sheahan P (2014) Vitamin D and risk of postoperative hypocalcemia after total thyroidectomy. JAMA Otolaryngol Head Neck Surg 140:346–351

    Article  PubMed  Google Scholar 

  23. Nhan C, Dolev Y, Mijovic T et al (2012) Vitamin D deficiency and the risk of hypocalcemia following total thyroidectomy. J Otolaryngol Head Neck Surg 41:401–406

    PubMed  Google Scholar 

  24. Holick MF, Binkley NC, Bischoff-Ferrari HA et al (2011) Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96:1911–1930

    Article  CAS  PubMed  Google Scholar 

  25. Thomusch O, Machens A, Sekulla C et al (2000) Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg 24:1335–1341

    Article  CAS  PubMed  Google Scholar 

  26. Gourgiotis S, Moustafellos P, Dimopoulos N et al (2006) Inadvertent parathyroidectomy during thyroid surgery: the incidence of a complication of thyroidectomy. Langenbecks Arch Surg 391:557–560

    Article  PubMed  Google Scholar 

  27. Abboud B, Sargi Z, Akkam M et al (2002) Risk factors for postthyroidectomy hypocalcemia. J Am Coll Surg 195:456–461

    Article  PubMed  Google Scholar 

  28. Choi HS, Oh HJ, Choi H et al (2011) Vitamin D insufficiency in Korea—a greater threat to younger generation: the Korea National Health and Nutrition Examination Survey (KNHANES) 2008. J Clin Endocrinol Metab 96:643–651

    Article  CAS  PubMed  Google Scholar 

  29. Choi HS (2013) Vitamin D status in Korea. Endocrinol Metab (Seoul) 28:12–16

    Article  Google Scholar 

  30. Choi YM, Kim WG, Kim TY et al (2014) Low levels of serum vitamin D3 are associated with autoimmune thyroid disease in pre-menopausal women. Thyroid 24:655–661

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Kim JR, Kim BH, Kim SM, et al. (2014) Low serum 25 hydroxyvitamin D is associated with poor clinicopathologic characteristics in female patients with papillary thyroid cancer. Thyroid 24(11):1618–1624

  32. Roh JL, Park JY, Park CI (2007) Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg 245:604–610

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

This study was supported by a grant of the KCCH Research Competence Promotion (KRP), Korea Institute of Radiological and Medical Sciences (50246–2014).

Conflicts of interest

The authors declare that they have no conflict of interest.

Authors’ contribution

G. H. L. and M. J. K. contributed to the study conception and design, analysis and interpretation of data, and drafting of the manuscript. G. H. L. and M. L. collected the data. Y. H. K. and H. I. K. participated in the drafting and critical revision of the manuscript.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Korea Cancer Center Hospital, 75, Nowon-ro, No-won-gu, Seoul, 139-709, Republic of Korea

    Guk Haeng Lee & Myung-Chul Lee

  2. Department of Internal Medicine, Korea Cancer Center Hospital, 75, Nowon-ro, No-won-gu, Seoul, 139-709, Republic of Korea

    Yun Hyi Ku, Hong Il Kim & Min Joo Kim

Authors
  1. Guk Haeng Lee
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  2. Yun Hyi Ku
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  3. Hong Il Kim
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  4. Myung-Chul Lee
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  5. Min Joo Kim
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Corresponding author

Correspondence to Min Joo Kim.

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Lee, G.H., Ku, Y.H., Kim, H.I. et al. Vitamin D level is not a predictor of hypocalcemia after total thyroidectomy. Langenbecks Arch Surg 400, 617–622 (2015). https://doi.org/10.1007/s00423-015-1311-1

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  • DOI: https://doi.org/10.1007/s00423-015-1311-1

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