Correlating pre-operative vitamin D status with post-thyroidectomy hypocalcemia.

OBJECTIVE To examine the relationship between pre-operative vitamin D status and post-thyroidectomy hypocalcemia. METHODS Retrospective study examining 264 total and completion thyroidectomies conducted between 2007 and 2011. Subjects included had a recorded 25-hydroxyvitamin D (25[OH]D) level within 21 days prior to or 1 day following surgery, did not have a primary parathyroid gland disorder, and were not taking 1,25-dihydroxyvitamin D3 (calcitriol) prior to surgery. Some subjects were repleted with vitamin D pre-operatively if a low 25(OH)D level (typically below 20 ng/mL) was identified. Pre-operative 25(OH)D, concurrent neck dissection, integrity of parathyroid glands, final pathology, postoperative parathyroid hormone (PTH), calcium nadir and repletion, and length of stay were examined. RESULTS The mean pre-operative 25(OH)D for all subjects was 25 ng/mL, and the overall rate of post-operative hypocalcemia was 37.5%. Lower pre-operative 25(OH)D did not predict postoperative hypocalcemia (P = .96); however, it did predict the need for postoperative 1,25-dihydroxyvitamin D3 administration (P = .01). Lower postoperative PTH levels (P = .001) were associated with postoperative hypocalcemia. CONCLUSION Pre-operative 25(OH)D did not predict a postoperative decrease in serum calcium, although it did predict the need for 1,25-dihydroxyvitamin D3 therapy in hypocalcemic subjects. We recommend that 25(OH)D be assessed and, if indicated, repleted pre-operatively in patients undergoing total thyroidectomy.

[1]  Glenville Jones.  Interpreting vitamin D assay results: proceed with caution. , 2015, Clinical journal of the American Society of Nephrology : CJASN.

[2]  R. Heaney.  Health is better at serum 25(OH)D above 30ng/mL , 2013, The Journal of Steroid Biochemistry and Molecular Biology.

[3]  I. Millán,et al.  The prevalence of vitamin deficiency in clinical practice is assay-dependent. , 2012, Clinical nutrition.

[4]  C. Gordon,et al.  Guidelines for preventing and treating vitamin D deficiency and insufficiency revisited. , 2012, The Journal of clinical endocrinology and metabolism.

[5]  G. Agarwal,et al.  The impact of vitamin D status and tumor size on the intraoperative parathyroid hormone dynamics in patients with symptomatic primary hyperparathyroidism , 2012, Surgery Today.

[6]  C. Gordon,et al.  Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. , 2011, The Journal of clinical endocrinology and metabolism.

[7]  H. Issever,et al.  Determinants of postoperative hypocalcemia in vitamin D-deficient Graves' patients after total thyroidectomy. , 2011, American journal of surgery.

[8]  M. Holick.  Vitamin D: evolutionary, physiological and health perspectives. , 2011, Current drug targets.

[9]  H. Markogiannakis,et al.  Preoperative Vitamin D Deficiency Predicts Postoperative Hypocalcemia After Total Thyroidectomy , 2011, World Journal of Surgery.

[10]  Z. El-Khatib,et al.  25-hydroxy vitamin D deficiency causes parathyroid incidentalomas , 2010, Langenbeck's Archives of Surgery.

[11]  Stephanie L. Lee,et al.  Prediction of hypocalcemia after using 1‐ to 6‐hour postoperative parathyroid hormone and calcium levels: An analysis of pooled individual patient data from 3 observational studies , 2009, Head & neck.

[12]  H. Issever,et al.  The impact of age, vitamin D(3) level, and incidental parathyroidectomy on postoperative hypocalcemia after total or near total thyroidectomy. , 2009, American journal of surgery.

[13]  N. Perrier,et al.  Peer-Reviewed, Evidence-Based Analysis of Vitamin D and Primary Hyperparathyroidism , 2009, World Journal of Surgery.

[14]  J. Roh,et al.  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 , 2009, Cancer.

[15]  J. Valdivielso,et al.  Simultaneous changes in the calcium-sensing receptor and the vitamin D receptor under the influence of calcium and calcitriol. , 2008, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[16]  Stephanie L. Lee,et al.  Early prediction of hypocalcemia after thyroidectomy using parathyroid hormone: an analysis of pooled individual patient data from nine observational studies. , 2007, Journal of the American College of Surgeons.

[17]  J. Roh,et al.  Routine oral calcium and vitamin D supplements for prevention of hypocalcemia after total thyroidectomy. , 2006, American journal of surgery.

[18]  B. Barraclough,et al.  Parathyroid Autotransplantation during Total Thyroidectomy—Does the Number of Glands Transplanted Affect Outcome? , 2005, World Journal of Surgery.

[19]  C. Sekulla,et al.  The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. , 2003, Surgery.

[20]  M. Holick,et al.  Vitamin D insufficiency among free-living healthy young adults. , 2002, The American journal of medicine.

[21]  Beretta,et al.  Calcium‐sensing receptor expression and signalling in human parathyroid adenomas and primary hyperplasia , 2000, Clinical endocrinology.

[22]  Md. Hasan Raza Ansari,et al.  Effect of vitamin D nutrition on parathyroid adenoma weight: pathogenetic and clinical implications. , 2000, The Journal of clinical endocrinology and metabolism.

[23]  F. Pattou,et al.  Hypocalcemia following Thyroid Surgery: Incidence and Prediction of Outcome , 1998, World Journal of Surgery.

[24]  M. Holick,et al.  Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. , 1988, The Journal of clinical endocrinology and metabolism.