Preoperative Vitamin D Deficiency Predicts Postoperative Hypocalcemia After Total Thyroidectomy

World Journal of Surgery volume 35, pages324–330(2011)Cite this article

Abstract

Background

Transient postthyroidectomy hypocalcemia occurs in up to 30% of patients. We evaluated the effect of vitamin D deficiency on postthyroidectomy hypocalcemia.

Methods

Data were collected prospectively between January 2006 and March 2009. A total of 166 consecutive total thyroidectomies were analyzed regarding the relation between preoperative vitamin D3 levels and postoperative corrected calcium levels. Patients were divided into three groups dependent upon the preoperative vitamin D3 level: group 1, <25 nmol/l; group 2, 25–50 nmol/l; group 3, >50 nmol/l (conversion factor of 2.5× between nanomoles per liter and nanograms per milliliter). Hypocalcemia was defined as a postoperative calcium level <2.00 mmol/l (8 mg/dl). Hospital length of stay was recorded.

Results

There was a difference in postoperative hypocalcemia between the three vitamin D3 groups (group 1 (32%) vs. group 2 (24%) vs. group 3 (13%). Hypocalcemia in group 1 (vit D <25 nmol/l, <10 ng/ml) was significantly more likely than in group 3 (vit D >50 nmol/l, >20 ng/ml) (P = 0.025, χ2 test. Vitamin D3 deficiency was also associated with a longer hospital stay (median stay 2 days vs. 1 day, P < 0.001, Wilcoxon rank test).

Conclusions

There is a significant difference in postoperative hypocalcemia rates between those with vitamin D levels >50 nmol/l (>20 ng/ml) and those with a level of <25 nmol/l (<10 ng/ml). Vitamin D deficiency leads to a delay in discharge owing to a higher likelihood of hypocalcemia.

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References

  1. 1.

    Pappalardo G, Guadalaxara A, Frattaroli FM et al (1998) Total compared with subtotal thyroidectomy in benign nodular disease: personal series and review of published reports. Eur J Surg 164:501–506

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    BAETS (2009) In: Scott-Coombes D (eds) British association of endocrine and thyroid surgeons third national audit report. Dendrite Clinical Systems. BAETS, Henley-on-Thames

  3. 3.

    Peix JL, Zabot JM (1988) Complications and sequelae of thyroid surgery. Presse Med 17:1749–1753

    CAS  PubMed  Google Scholar 

  4. 4.

    Pederson WC, Johnson CL, Gaskill HV et al (1984) Operative management of thyroid disease: technical considerations in a residency training program. Am J Surg 148:350–352

    CAS  Article  PubMed  Google Scholar 

  5. 5.

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

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    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

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    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

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Thomusch O, Machens A, Sekulla C et al (2003) The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery 133:180–185

    Article  PubMed  Google Scholar 

  9. 9.

    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

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Tartaglia F, Giuliani A, Sgueglia M et al (2005) Randomized study on oral administration of calcitriol to prevent symptomatic hypocalcemia after total thyroidectomy. Am J Surg 190:424–429

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    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 1112–1113

    Article  PubMed  Google Scholar 

  12. 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

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Testa A, Fant V, De Rosa A et al (2006) Calcitriol plus hydrochlorothiazide prevents transient post-thyroidectomy hypocalcemia. Horm Metab Res 38:821–826

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Weaver S, Doherty DB, Jimenez C et al (2009) Peer-reviewed, evidence-based analysis of vitamin D and primary hyperparathyroidism. World J Surg 33:2292–2302

    Article  PubMed  Google Scholar 

  15. 15.

    Melamed ML, Muntner P, Michos ED et al (2008) Serum 25-hydroxyvitamin D levels and the prevalence of peripheral arterial disease: results from NHANES 2001 to 2004. Arterioscler Thromb Vasc Biol 28:1179–1185

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Geller JL, Hu B, Reed S et al (2008) Increase in bone mass after correction of vitamin D insufficiency in bisphosphonate-treated patients. Endocr Pract 14:293–297

    PubMed  Google Scholar 

  17. 17.

    Welbourn RB (1990) The history of endocrine surgery. Praeger, New York

    Google Scholar 

  18. 18.

    Palazzo FF, Sywak MS, Sidhu SB et al (2005) Parathyroid autotransplantation during total thyroidectomy: does the number of glands transplanted affect outcome? World J Surg 29:629–631

    Article  PubMed  Google Scholar 

  19. 19.

    Lo CY, Luk JM, Tam SC (2002) Applicability of intraoperative parathyroid hormone assay during thyroidectomy. Ann Surg 236:564–569

    Article  PubMed  Google Scholar 

  20. 20.

    Soon PS, Magarey CJ, Campbell P et al (2005) Serum intact parathyroid hormone as a predictor of hypocalcemia after total thyroidectomy. ANZ J Surg 75:977–980

    Article  PubMed  Google Scholar 

  21. 21.

    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

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Payne RJ, Hier MP, Tamilia M et al (2005) Same-day discharge after total thyroidectomy: the value of 6-hour serum parathyroid hormone and calcium levels. Head Neck 27:1–7

    Article  PubMed  Google Scholar 

  23. 23.

    Sywak MS, Palazzo FF, Yeh M et al (2007) Parathyroid hormone assay predicts hypocalcemia after total thyroidectomy. ANZ J Surg 77:667–670

    Article  PubMed  Google Scholar 

  24. 24.

    Lam A, Kerr PD (2003) Parathyroid hormone: an early predictor of postthyroidectomy hypocalcemia. Laryngoscope 113:2196–2200

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Cahill RA, Harty R, Cotter S et al (2006) Parathormone response to thyroid surgery. Am J Surg 191:453–459

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Nygren P, Larsson R, Johansson H et al (1988) 1,25 (OH)2D3 inhibits hormone secretion and proliferation but not functional dedifferentiation of cultured bovine parathyroid cells. Calcif Tissue Int 43:213–218

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Carrillo-López N, Fernández-Martín JL, Cannata-Andía JB (2009) The role of calcium, calcitriol and their receptors in parathyroid regulation. Nefrologia 29:103–108

    PubMed  Google Scholar 

  28. 28.

    Carrillo-López N, Alvarez-Hernández D, González-Suárez I et al (2008) Simultaneous changes in the calcium-sensing receptor and the vitamin D receptor under the influence of calcium and calcitriol. Nephrol Dial Transplant 23:3479–3484

    Article  PubMed  Google Scholar 

  29. 29.

    Garfia B, Canadillas S, Canalejo A et al (2002) Regulation of parathyroid vitamin D receptor expression by extracellular calcium. J Am Soc Nephrol 13:2945

    CAS  Article  PubMed  Google Scholar 

  30. 30.

    Kirkby-Bott J, El-Khatib Z, Caiazzo R et al (2010) Vitamin D3 deficiency causes asymmetrical parathyroid hyperplasia. Langenbecks Arch Surg 395:474

    Article  Google Scholar 

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Conflicts of interest

The authors have no conflicts to disclose.

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Affiliations

  1. Department of Endocrine Surgery, Hammersmith Hospital, Imperial College NHS Trust, Du Cane Road, London, W12 0HS, UK

    James Kirkby-Bott, Haridimos Markogiannakis, Anita Skandarajah, Bill Fleming & Fausto Palazzo

  2. Division of Cellular and Molecular Medicine, St. George’s, University of London, London, SW17 0RE, UK

    Matthew Cowan

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  1. James Kirkby-Bott
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  2. Haridimos Markogiannakis
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  3. Anita Skandarajah
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  4. Matthew Cowan
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  5. Bill Fleming
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  6. Fausto Palazzo
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Correspondence to Fausto Palazzo.

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Kirkby-Bott, J., Markogiannakis, H., Skandarajah, A. et al. Preoperative Vitamin D Deficiency Predicts Postoperative Hypocalcemia After Total Thyroidectomy. World J Surg 35, 324–330 (2011). https://doi.org/10.1007/s00268-010-0872-y

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Keywords

  • Parathyroid Gland
  • Total Thyroidectomy
  • Normal Reference Range
  • Permanent Hypoparathyroidism
  • Corrected Calcium