Role of Preoperative Calcium and Vitamin D Supplementation in Preventing Post-total Thyroidectomy Hypocalcemia
MV Sasi, M Shreyamsa, Surabhi Garg, Loreno Enny, Kul R Singh, Chanchal Rana, Pooja Ramakant, Anand Mishra
Postoperative hypocalcemia, Thyroidectomy, Vitamin D deficiency
Citation Information :
Sasi M, Shreyamsa M, Garg S, Enny L, Singh KR, Rana C, Ramakant P, Mishra A. Role of Preoperative Calcium and Vitamin D Supplementation in Preventing Post-total Thyroidectomy Hypocalcemia. World J Endoc Surg 2022; 14 (1):7-14.
Introduction: Thyroidectomy is the commonest endocrine surgical procedure. Transient hypocalcemia occurs in the range of 19–38%. Though many parameters are being attributed to postthyroidectomy hypocalcemia, preoperative vitamin D and calcium supplementation seem to be debated. The objective of this study was to find out the benefits of preoperative calcium and vitamin D supplement in preventing postthyroidectomy hypocalcemia.
Subjects and methods: This was a prospective randomized study conducted from 1st April 2018 to 31st July 2019. Total thyroidectomy (TT) was performed in all patients for various thyroid disorders. Group A received no preoperative supplements and group B received 6 weeks 2 gm calcium carbonate with weekly cholecalciferol 60,000 units for 6 weeks before surgery. The preoperative biochemical panel, bone mineral density, intraoperative factors, postoperative blood parameters, and clinical effects were analyzed.
Results: Of 133 patients who underwent TT in the above period, 83 patients were included in the study, group A (n = 42) and group B (n = 41). Mean age was 41.6 ± 13.39 years (range: 18–74). Female:male was 11:1. Clinical hypocalcemia occurred in 37.3% (n = 31), group A (n = 19) vs group B (n = 12) (p = 0.197). Vitamin D deficiency was seen in 74.7% (n = 62), group A 76.2% (n = 32) vs group B 73.2% (n = 30) (p = 0.804). Postoperative calcium levels were significantly correlated to preoperative magnesium (r = 0.222, p = 0.043), and postoperative day (POD)-1 parathyroid hormone (PTH) levels (r = 0.219, p = 0.047). On multiple linear regression analysis, both were not statistically significant with preoperative magnesium levels (β = 0.194, p = 0.077) and POD-1 PTH (β = 0.190, p = 0.083). The number of parathyroid glands visualized was the only significant independent variable in a separate multiple linear regression analysis (β = 0.598, p = 0.019). When the number of parathyroid glands visualized was less than two, the hypocalcemia increased with an odds ratio (OR) 1.132, 95% confidence interval: 0.068–18.719.
Conclusion: Preoperative calcium and vitamin D supplementation did result in lowering post-TT hypocalcemia and hospital stay.
Ho TW, Shaheen AA, Dixon E, et al. Utilization of thyroidectomy for benign disease in the United States: a 15-year population-based study. Am J Surg 2011;201(5):570–574. DOI: 10.1016/j.amjsurg.2010.12.006
Orloff LA, Wiseman SM, Bernet VJ et al. American Thyroid Association statement on postoperative hypoparathyroidism: diagnosis, prevention, and management in adults. Thyroid 2018;28(7):830–841. DOI: 10.1089/thy.2017.0309
Seo ST, Chang JW, Jin J, et al. Transient and permanent hypocalcemia after total thyroidectomy: early predictive factors and long-term follow-up results. Surgery 2015;158(6):1492–1499. DOI: 10.1016/j.surg.2015.04.041
Stack BC, Bimston DN, Bodenner DL, et al. AACE/ACE disease state clinical review: postoperative hypoparathyroidism. Endocr Pract 2015;21(6):674–685. DOI: 10.4158/EP14462.DSC
Ritu G, Gupta A. Vitamin D deficiency in India: prevalence, causalities, and interventions. Nutrients 2014;6(2):729–775. DOI:10.3390/nu6020729
Aparna P, Muthathal S, Baridalyne N, et al. Vitamin D deficiency in India. J Family Med Prim Care 2018;7(2):324–330. DOI: 10.4103/jfmpc.jfmpc_78_18
Erbil Y, Bozbora A, Ozbey N, et al. Predictive value of age and serum parathormone and vitamin D3 levels for postoperative hypocalcemia after total thyroidectomy for nontoxic multinodular goiter. Arch Surg 2007;142(12)1182–1187 DOI: 10.1001/archsurg.142.12.1182
Tripathi M, Karwasra RK, Sanjeev P. Effect of preoperative vitamin D deficiency on postoperative hypocalcemia after thyroid surgery Thyroid Res 2014;7:8. DOI: 10.1186/1756-6614-7-8
Kirkby-Bott J, Markogiannakis H, Skandarajah A, et al. Preoperative vitamin D deficiency predicts postoperative hypocalcemia after total thyroidectomy. World J Surg 2011;35(2):324–330. DOI: 10.1007/s00268-010-0872-y
Erbil Y, Barbaros U, Temel B, et al. The impact of age, vitamin D3 level, and incidental parathyroidectomy on postoperative hypocalcemia after total or near total thyroidectomy. Am J Surg 2009;197(4):439–446. DOI: 10.1016/j.amjsurg.2008.01.032
Díez M, Vera C, Ratia T, et al. Effect of vitamin D deficiency on hypocalcaemia after total thyroidectomy due to benign goitre. Cir Esp 2013;91(4):250–256. DOI: 10.1016/j.ciresp.2012.09.006
Salinger EM, Moore JT. Perioperative indicators of hypocalcemia in total thyroidectomy: the role of vitamin D and parathyroid hormone. Am J Surg 2013;206(6):876–882. DOI: 10.1016/j.amjsurg.2013.08.020
Lang B, Wong KP, Cheung CY, et al. Does preoperative 25-hydroxyvitamin D status significantly affect the calcium kinetics after total thyroidectomy? World J Surg 2013;37(7):1592–1598. DOI: 10.1007/s00268-013-2015-8
Jaan S, Sehgal A, Rauf AW, et al. Usefulness of pre- and post-operative calcium and Vitamin D supplementation in prevention of hypocalcemia after total thyroidectomy: a randomized controlled trial. Indian J Endocrinol Metab 2018;21(1):51–55. DOI: 10.4103/2230-8210.195997n>
Ravikumar K, Dhalapathy S, Muthukumar S, et al. A Prospective study on role of supplemental oral calcium and vitamin D in prevention of postthyroidectomy hypocalcemia. Indian J Endocrinol Metab 2017;21(4):498–503. DOI: 10.4103/ijem.IJEM_402_16
Shoback D. Clinical practice. Hypoparathyroidism. N Engl J Med 2008;359:391–403. DOI: 10.1056/NEJMcp0803050.
Cherian AJ, Ponraj S, Gowri S M, et al. The role of vitamin D in post-thyroidectomy hypocalcemia: still an enigma. Surgery 2015;159(2):532–538. DOI: 10.1016/j.surg.2015.08.014
Kurukahvecioglu O, Karamercan A, Akin M, et al. Potential benefit of oral calcium/vitamin D administration for prevention of symptomatic hypocalcemia after total thyroidectomy. Endocr Regul 2007;41(1):35–39. PMID: 17437343.
Nemade SV, Rokade VV, Pathak NA, et al. Comparison between perioperative treatment with calcium and with calcium and vitamin d in prevention of post thyroidectomy hypocalcemia. Indian J Otolaryngol Head Neck Surg 2014;66(Suppl 1):214–219. DOI: 10.1007/s12070-011-0430-4
IM Arer, Kus M, Akkapulu N, et al. Prophylactic oral calcium supplementation therapy to prevent early post thyroidectomy hypocalcemia and evaluation of postoperative parathyroid hormone levels to detect hypocalcemia: a prospective randomized study. Int J Surg 2017;38:9–14. DOI: 10.1016/j.ijsu.2016.12.041
Langner E, Tincani AJ, Negro A. Use of prophylactic oral calcium after total thyroidectomy: a prospective study. Arch Endocrinol Metab 2017;61(5):447–454. DOI: 10.1590/2359-3997000000286
Maxwell AK, Shonka DC, Robinson DJ et al. Association of preoperative calcium and calcitriol therapy with postoperative hypocalcemia after total thyroidectomy. JAMA Otolaryngol Head Neck Surg 2017;143(7):679–684. DOI: 10.1001/jamaoto.2016.4796
Malik MZ, Mirza AA, Farooqi SA, et al. Role of preoperative administration of vitamin D and calcium in postoperative transient hypocalcemia after total thyroidectomy. Cureus 2019;11(4):e4579. DOI: 10.7759/cureus.4579