Preoperative Vitamin.D Status and Post-Total Thyroidectomy Hypocalcemia

Document Type : Original

Authors

1 Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Department of Otorhinolaryngology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Nanotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction:
Hypocalcemia is a common complication of total thyroidectomy (TT). This study was designed to investigate the effect of preoperative vitamin.D (Vit.D) status on the occurrence of post-total thyroidectomy hypocalcemia.
Materials and Methods:
Patients who underwent TT without parathyroidectomy were divided into three groups based on their preoperative Serum Vit.D levels (<20 ng/ml, 20-30 ng/ml, and ≥30 ng/ml were considered deficient, insufficient, and normal Vit.D levels, respectively). Serum levels of calcium and phosphorus were measured before and 24 hours after surgery in all patients. The patients were examined for clinical symptoms and signs of hypocalcemia postoperatively. In cases with positive clinical symptoms and signs of hypocalcemia and/or calcium levels <8 mg/dl, PTH level was measured before starting calcium infusion, while serum calcium and phosphorus levels were also measured 24 hours later.
Results:
Among 100 patients enrolled in this study, 81% were females. The mean age was 36.60±8.32 years. Before surgery, the mean Vit.D level was 26.9±16.89 ng/ml, while 47% of cases had normal Vit.D level, 32% had insufficient vitamin levels, and 21% had Vit.D deficiency. Twenty-four hours after surgery, the calcium (P=0.356) and phosphorus (P=0.743) levels were not significantly different between the three Vit.D groups. A comparison of postoperative PTH levels between the three Vit.D groups showed no significant difference (P=0.596).
Conclusions:
Based on our findings, preoperative serum Vit.D levels did not affect postoperative serum calcium levels.

Keywords

Main Subjects

References

  1. Padur AA, Kumar N, Guru A, Badagabettu SN, Shanthakumar SR, Virupakshamurthy MB, et al. Safety and effectiveness of TT and its comparison with subTT and other thyroid surgeries: a systematic review. Journal of thyroid research. 2016;2016.
  2. Christou N, Mathonnet M. Complications after TT. Journal of visceral surgery. 2013;150(4):249-56.
  3. Dionigi G, Bacuzzi A, Bertocchi V, Carrafiello G, Boni L, Rovera F, et al. Prospectives and surgical usefulness of perioperative parathyroid hormone assay in thyroid surgery. Expert Review of Medical Devices. 2008;5(6):699-704.
  4. Dedivitis RA, Pfuetzenreiter Jr EG, Nardi CEM, Barbara ECDd. Prospective study of clinical and laboratorial hypocalcemia after thyroid surgery. Brazilian journal of otorhinolaryngology. 2010;76:71-7.
  5. Ru Z, Mingliang W, Maofei W, Qiaofeng C, Jianming Y. Analysis of risk factors for hypoparathyroidism after TT. Frontiers in Surgery. 2021;8:668498.
  6. Orloff LA, Wiseman SM, Bernet VJ, Fahey III TJ, Shaha AR, Shindo ML, et al. American Thyroid Association statement on postoperative hypoparathyroidism: diagnosis, prevention, and management in adults. Thyroid. 2018;28(7):830-41.
  7. Khammissa R, Fourie J, Motswaledi M, Ballyram R, Lemmer J, Feller L. The biological activities of Vit.D and its receptor in relation to calcium and bone homeostasis, cancer, immune and cardiovascular systems, skin biology, and oral health. BioMed research international. 2018;2018.
  8. Kirkby-Bott J, Markogiannakis H, Skandarajah A, Cowan M, Fleming B, Palazzo F. Preoperative Vit.D deficiency predicts postoperative hypocalcemia after TT. World journal of surgery. 2011;35:324-30.
  9. Danan D, Shonka Jr DC. Preoperative Vit.D level as predictor of post‐thyroidectomy hypocalcemia in patients sustaining transient parathyroid injury. Head & Neck. 2017;39(7):1378-81.
  10. Erbil Y, Ozbey NC, Sari S, Unalp HR, Agcaoglu O, Ersöz F, et al. Determinants of postoperative hypocalcemia in Vit.D –deficient Graves’ patients after TT. The American journal of surgery. 2011;201(5):685-91.
  11. Erbil Y, Barbaros U, Temel B, Turkoglu U, İşsever H, Bozbora A, et al. The impact of age, Vit.D 3 level, and incidental parathyroidectomy on postoperative hypocalcemia after total or near TT. The American Journal of Surgery. 2009;197(4):439-46.
  12. Griffin TP, Murphy MS, Sheahan P. Vit.D and risk of postoperative hypocalcemia after TT. JAMA Otolaryngology–Head & Neck Surgery. 2014;140(4):346-51.
  13. Dağlar G, Kiliç M, Çelik C, Yüksel C, Terzioğlu S, Özden S, et al. Is there a relatIonshIp between Vit.D status anD hypocalcemIa after TT? Acta Endocrinologica (Bucharest). 2016;12(3):291.
  14. Vatandost S, Jahani M, Afshari A, Amiri MR, Heidarimoghadam R, Mohammadi Y. Prevalence of Vit.D deficiency in Iran: a systematic review and meta-analysis. Nutrition and health.        

2018;24(4):269-78.

  1. Ozogul B, Akcay MN, Akcay G, Bulut OH. Factors affecting hypocalcaemia following TT: a prospective study. The Eurasian journal of medicine. 2014;46(1):15.
  2. Al-Khatib T, Althubaiti AM, Althubaiti A, Mosli HH, Alwasiah RO, Badawood LM. Severe Vit.D deficiency: a significant predictor of early hypocalcemia after TT. Otolaryngology–Head and Neck Surgery. 2015;152(3):424-31.
  3. Bove A, Dei Rocini C, Di Renzo R, Farrukh M, Palone G, Chiarini S, et al. Vit.D deficiency as a predictive factor of transient hypocalcemia after TT. International Journal of Endocrinology. 2020;2020.
  4. Cherian AJ, Ponraj S, Ramakant P, Paul TV, Abraham DT, Paul M. The role of Vit.D in post-thyroidectomy hypocalcemia: still an enigma. Surgery. 2016;159(2):532-8.
  5. Wang X, Zhu J, Liu F, Gong Y, Li Z. Preoperative Vit.D deficiency and postoperative hypocalcemia in thyroid cancer patients undergoing TT plus central compartment neck dissection. Oncotarget. 2017;8(44):78113.
  6. Hemmati H, Poursafar M, Farzin M, Motamed B, Samidoost P, Rafiei E, et al. The Serum Level of Vit.D and Hypocalcemia in Thyroidectomy Candidate Patients Referred to a Tertiary Care Hospital in the North of Iran. 2020.
  7. Soares CSP, Tagliarini JV, Mazeto GM. Preoperative Vit.D level as a post-TT hypocalcemia predictor: a prospective study. Brazilian journal of otorhinolaryngology. 2021;87:85-9.
  8. Godazandeh G, Kashi Z, Godazandeh F, Tayebi P, Bijani A. Influence of thyroidectomy on postoperative serum calcium level regarding serum Vit.D A prospective study. Caspian journal of internal medicine. 2015;6(2):72.
  9. Singh G, Irshaidat F, Lau C, Pedoeem A, Feng C, Fariduddin MM, et al. Advancing the understanding of Vit.D status in Post-Thyroidectomy Hypocalcemia. International Journal of Endocrinology. 2021;2021.
  10. Karunakaran P, Abraham DT, Devadas G, Hussain Z, Kanakasabapathi R. Is Preoperative Vit.D Deficiency a Predictor of Transient and Permanent Hypocalcemia After TT? A Cohort Study in a Tertiary Care Hospital. Indian Journal of Surgery. 2021:1-8.
  11. Vibhatavata P, Pisarnturakit P, Boonsripitayanon M, Pithuksurachai P, Plengvidhya N, Sirinvaravong S. Effect of preoperative Vit.D deficiency on hypocalcemia in patients with acute hypoparathyroidism after thyroidectomy. International Journal of Endocrinology. 2020;2020.
  12. Unsal IO, Calapkulu M, Sencar ME, Hepsen S, Sakiz D, Ozbek M, et al. Preoperative Vit.D levels as a predictor of transient hypocalcemia and hypoparathyroidism after parathyroidectomy. Scientific reports. 2020;10(1):9895.
  13. Choi EHE, Qeadan F, Alkhalili E, Lovato C, Burge MR. Preoperative Vit.D deficiency is associated with increased risk of postoperative hypocalcemia after TT. Journal of Investigative Medicine. 2021;69(6):1175-81.
  14. Carvalho GBd, Giraldo LR, Lira RB, Macambira IBM, Tapia MA, Kohler HF, et al. Preoperative Vit.D deficiency is a risk factor for postoperative hypocalcemia in patients undergoing TT: retrospective cohort study. Sao Paulo Medical Journal. 2019;137:241-7.
  15. Qi Y, Chai J, Zhang L, Chen Y. Preoperative Vit.D level is significantly associated with hypocalcemia after TT. BMC Musculoskeletal Disorders. 2022;23(1):1118.
  16. Tripathi M, Karwasra RK, Parshad S. Effect of preoperative Vit.D deficiency on postoperative hypocalcemia after thyroid surgery. Thyroid research. 2014;7:1-6.
  17. Alkhalili E, Ehrhart MD, Ayoubieh H, Burge MR. Does pre-operative Vit.D deficiency predict postoperative hypocalcemia after thyroidectomy? Endocrine Practice. 2017;23(1):5-9.
  18. Qin Y, Sun W, Wang Z, Dong W, He L, Zhang T, et al. A meta-analysis of risk factors for transient and permanent hypocalcemia after TT. Frontiers in Oncology. 2021;10:614089.
  19. Chen Z, Zhao Q, Du J, Wang Y, Han R, Xu C, et al. Risk factors for postoperative hypocalcaemia after thyroidectomy: A systematic review and meta-analysis. Journal of International Medical Research. 2021;49(3):1-21.

 

Iranian Journal of Otorhinolaryngology
Volume 36, Issue 1
January and February 2024
Pages 343-348

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