The Southwestern Surgical Congress
Vitamin D deficiency does not increase the rate of postoperative hypocalcemia after thyroidectomy

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Background

Hypocalcemia is a frequent complication of thyroidectomy. Although typically mild and temporary, it can lead to an increased length of stay, readmission, and in some cases be permanent. Controversy exists as to whether vitamin D deficiency (VDD) contributes to post-thyroidectomy hypocalcemia.

Methods

This is a retrospective study of 152 patients who underwent thyroidectomy. Patients with or without VDD were compared. Data were analyzed for demographics, operative procedure, calcium levels, and complications of hypocalcemia.

Results

There was no difference in the rates of biochemical or symptomatic hypocalcemia or in the need for readmission between the VDD and non-VDD groups. A multivariate analysis controlling for central neck dissection, parathyroid autotransplant, and preoperative diagnosis confirmed no association between VDD and post-thyroidectomy hypocalcemia.

Conclusions

Despite VDD being common in patients undergoing thyroidectomy, our results do not suggest that this increases the rate of hypocalcemia. Thus, preoperative evaluation/repletion of VDD is unlikely to reduce post-thyroidectomy hypocalcemia rates.

Section snippets

Patients

Approval for this study was granted by the Colorado Multiple Institutional Review Board (protocol 10-1477). A retrospective analysis was performed of 152 patients undergoing near-total thyroidectomy between 2007 and 2011 for whom a 25-hydroxyvitamin D level was drawn at the preoperative appointment. All surgeries were performed at the University of Colorado Hospital by 1 of 2 experienced endocrine surgeons (RCM or CDR). Patients were excluded if they had undergone previous thyroid or

Results

A total of 152 patients were included in the study. Seventy-eight patients (51%) had a preoperative vitamin D level <30 ng/mL, and 31 (20%) had a level <20 ng/mL. Table 1 depicts the demographic, preoperative, and operative characteristics in each group. Groups were similar in age, sex, and whether the preoperative diagnosis was cancer or a suspicion for cancer. Compared with the control groups, body mass index was higher in those with a vitamin D level <30 ng/mL (29.6 kg/m2 ± 7.4 kg/m2 vs 26.4

Comments

Hypocalcemia is the most frequent complication after thyroidectomy.4, 18 Despite the fact that hypocalcemia is most commonly asymptomatic and transient, it can result in the need for additional medications, an increased length of stay, and readmissions, all of which are inconvenient and costly to the patient and health care system.1 Thus, the identification of a preoperative risk factor that could be modified to lower the risk of post-thyroidectomy hypocalcemia would be of great benefit.

Conclusions

Vitamin D deficiency was common in our population of patients undergoing thyroidectomy; however, it was not associated with an increased risk of postoperative hypocalcemia. Previous studies on this topic have reported contradictory findings, and we believe that a larger, prospective study is warranted to determine whether vitamin D deficiency is associated with post-thyroidectomy hypocalcemia.

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