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Is Preoperative Vitamin D Deficiency a Predictor of Transient and Permanent Hypocalcemia After Total Thyroidectomy? A Cohort Study in a Tertiary Care Hospital

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Abstract

The role of vitamin D as a predictor of postoperative hypocalcemia after total thyroidectomy (TT) has variable reports as it is latitude and population specific. This cohort study in South India evaluated the impact of preoperative serum 25-hydroxycholecalciferol (25OHD) levels on transient and permanent hypocalcemia (> 6 months) post-TT. Consecutive patients (n = 327; median age = 34 years; man:woman = 65:262) undergoing TT for benign or malignant thyroid diseases were evaluated for serum corrected calcium, intact parathormone and 25OHD (categorized as severe deficiency < 10; deficiency = 10–19.9; insufficiency = 20–29.9; sufficiency = 30–100 ng/mL) at baseline, 48-h and 6-month post-TT. The incidence of transient and permanent hypocalcemia (calcium < 8 mg/dL) post-TT was 33.3% and 7.9%, respectively, and preoperatively 13%. Patients with 25OHD severe deficiency (n = 44), deficiency (n = 131) and insufficiency (n = 109) had 20.2, 4.4 and 4.1 times higher odds of developing transient hypocalcemia, while preoperative hypocalcemia, malignancy, hyperthyroidism, thyroiditis and transient hypoparathyroidism were other significant predictors. Major determinants of permanent hypocalcemia were severe 25OHD deficiency and permanent hypoparathyroidism (each P < 0.05). In receiver operating characteristic, 25OHD reliably predicted transient hypocalcemia with threshold of 18.4 ng/mL. Areas under curve, sensitivity and specificity were 0.661 (P = 0.001), 60% and 59.4%, respectively. Low preoperative calcium and 25-hydroxycholecalciferol levels, widely prevalent in our population, were independent risk factors for transient and permanent hypocalcemia after total thyroidectomy. The risk of post-thyroidectomy hypocalcemia escalated many-fold with decreasing 25-hydroxycholecalciferol levels including insufficient range and prophylactic therapy may facilitate day-care surgery. Trial registration: This study is retrospectively registered with Research Registry and the unique identifying number is Research Registry 5818.

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Acknowledgements

We thank Dr. Srinivasan Ramalingam PhD, Senior Technical Officer, ICMR-National Institute for Research in Tuberculosis, Chetpet, Chennai-600031, for assistance in statistical analysis and interpretation of results.

Author information

Authors and Affiliations

  1. Department of Endocrine Surgery, Madras Medical College and Rajiv Gandhi Government General Hospital, 3rd Floor, Tower Block-1, EVR Salai, Park Town, Chennai, Tamil Nadu, India, 600003

    Poongkodi Karunakaran

  2. Government Mohan Kumaramangalam Medical College, Salem, India, 636030

    Poongkodi Karunakaran

  3. The Tamil Nadu Dr. M.G.R. Medical University, No 69, Anna Salai, Guindy, Chennai, Tamil Nadu, 600032, India

    Poongkodi Karunakaran

  4. Chennai, India

    Poongkodi Karunakaran

  5. Department of Endocrine Surgery, Christian Medical College, Vellore, 632004, India

    Deepak Thomas Abraham

  6. Institute of Pathology, Madras Medical College, Chennai, 600003, India

    Geetha Devadas

  7. Department of Endocrine Surgery, Madras Medical College, Chennai, 600003, India

    Zahir Hussain

  8. Institute of Biochemistry, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, 600003, India

    Ramadevi Kanakasabapathi

Authors
  1. Poongkodi Karunakaran
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  2. Deepak Thomas Abraham
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  5. Ramadevi Kanakasabapathi
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, data analysis and interpretation were performed by Dr K. Poongkodi. Dr K Poongkodi drafted the manuscript and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Poongkodi Karunakaran.

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Ethical Approval

This study was approved by the institutional Ethics committee, Madras Medical College, Chennai-3 (No.18092012). All procedures involving human participants were conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and later amendments. This article does not contain any studies with animals performed by any of the authors.

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Informed written consent obtained from all the individual participants included in the study.

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Informed written consent obtained from all the subjects included in the study regarding participation in this research and publication of their data.

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The authors declare no competing interests.

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Study design: Single-Centre Prospective Observational Study – Cohort study

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Karunakaran, P., Abraham, D.T., Devadas, G. et al. Is Preoperative Vitamin D Deficiency a Predictor of Transient and Permanent Hypocalcemia After Total Thyroidectomy? A Cohort Study in a Tertiary Care Hospital. Indian J Surg (2021). https://doi.org/10.1007/s12262-021-03183-5

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  • DOI: https://doi.org/10.1007/s12262-021-03183-5

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