The impact of age, vitamin D3 level, and incidental parathyroidectomy on postoperative hypocalcemia after total or near total thyroidectomy

doi:10.1016/j.amjsurg.2008.01.032

The American Journal of Surgery

Volume 197, Issue 4, April 2009, Pages 439-446

https://doi.org/10.1016/j.amjsurg.2008.01.032 Get rights and content

Abstract

Background

Hypocalcemia caused by transient or definitive hypoparathyroidism is the most frequent complication after thyroidectomy. We aimed to compare the impact of incidental parathyroidectomy and serum vitamin D₃ level on postoperative hypocalcemia after total thyroidectomy (TT) or near total thyroidectomy (NTT).

Patients

Two hundred consecutive patients with nontoxic multinodular goiter treated by TT and NTT were included prospectively in the present study. Group 1 (n = 49) consisted of patients with a postoperative serum calcium level ≤8 mg/dL, and group 2 (n = 151) had a postoperative serum calcium level greater than 8 mg/dL. Patients were evaluated according to age, preoperative serum 25-hydroxy vitamin D (25-OHD) levels, postoperative serum calcium levels, incidental parathyroidectomy, and the type of thyroidectomy.

Results

Patients in group 1 (n = 49) were hypocalcemic, whereas patients in group 2 (n = 151) were normocalcemic. Preoperative serum 25-OHD levels in group 1 were significantly lower than in group 2 (P < .001). The incidence of hypoparathyroidism was significantly higher following TT (13.5%) than following NTT (2.5%) (P < .05). The risk for postoperative hypocalcemia was increased 25-fold for patients older than 50 years, 28-fold for patients with a preoperative serum 25-OHD level less than 15 ng/mL, and 71-fold for patients who underwent TT. Incidental parathyroidectomy did not have an impact on postoperative hypocalcemia. The highest risk of postoperative hypocalcemia was found in the patients with all of the above variables.

Conclusions

Age, preoperative low serum 25-OHD, and TT are significantly associated with postoperative hypocalcemia. Patients with advanced age and low preoperative serum 25-OHD levels should be placed on calcium or vitamin D supplementation after TT to avoid postoperative hypocalcemia and decrease hospital stay.

Section snippets

Patients

A total of 200 consecutive patients with nontoxic multinodular goiter treated by bilateral TT and bilateral NTT in the Department of Surgery at the Istanbul Faculty of Medicine between January 2006 and January 2007 were included prospectively in the present study.

The main indications for surgery included large goiter with a compressive effect for all patients. Patients with hyperthyroidism, substernal goiter, previous thyroid or neck operations, or concomitant parathyroid disease, as well as

Results

The mean (±SD) age for all patients was 44.4 ± 12 years (range 17–72 years). The female/male ratio was 5.2/1 (n = 168/32). The means (±SD) for serum albumin, creatinine, calcium, alkaline phosphatase, and 25-OHD levels were 3.7 ± .06 g/dL, .8 ± .03 mg/dL, 8.8 ± .03 mg/dl, 158 ± 84 U/L, and 27.1 ± 13 ng/mL, respectively. The postoperative serum calcium level was lower than the preoperative serum calcium level (8.8 ± .3 mg/dL vs 8.2 ± .7 mg/dL, P < .001).

Incidental parathyroidectomy was found in

Comments

We investigated the prediction value of age, preoperative serum 25-OHD, and incidental parathyroidectomy on postoperative hypocalcemia after total and near total thyroidectomy. We found that age, preoperative low serum 25-OHD, and TT were significantly associated with postoperative hypocalcemia. Incidental parathyroidectomy did not impact postoperative hypocalcemia. A positive correlation was found between the serum calcium level and serum 25-OHD level, whereas negative correlations were

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Cited by (111)

Hungry Bone Syndrome Secondary to Subtotal Thyroidectomy in A Patient With Thyrotoxicosis
2021, American Journal of the Medical Sciences
Patients with thyrotoxicosis are prone to transient hypocalcemia after thyroidectomy, which may be due in part to surgical damage to the parathyroid glands. Hungry bone syndrome (HBS) can also cause hypocalcemia after thyroidectomy. HBS is due to increased osteoblast-mediated bone formation activity and normal or decreased bone resorption activity. As HBS is uncommon in patients after thyroidectomy, we herein present a case of hypocalcemia secondary to HBS after subtotal thyroidectomy for thyrotoxicosis in a 25-year-old woman with a two-month history of tingling extremities and carpopedal spasms after subtotal thyroidectomy for thyrotoxicosis. Diagnostic tests showed hypocalcemia and hyperphosphatemia with elevated parathyroid hormone levels and moderately decreased serum 25-hydroxyvitamin D levels. In addition to thyroid hormone replacement therapy, she was given calcitriol and Caltrate D (600 mg calcium plus 125 IU cholecalciferol). After two months of treatment, she no longer had spasms and her paresthesia improved. Meanwhile, serum electrolytes and parathyroid hormone levels had almost returned to the normal ranges. This is a rare case of HBS presented as a complication of subtotal thyroidectomy in a patient with thyrotoxicosis.
Risk factors for the development of hypocalcemia in pediatric patients after total thyroidectomy – A systematic review
2021, International Journal of Pediatric Otorhinolaryngology
Citation Excerpt :
It is worth noting this figure is skewed by de Jong and colleagues’ study[16], which reported a permanent hypoparathyroidism rate of 22%, higher than the other studies in our review (3–7%). Other possible explanations include different definitions of permanent hypocalcemia (6 versus 12 months or longer), a greater susceptibility to damage in the finer and more delicate anatomy of the pediatric population, and the effects of regional variations in undetected preoperative vitamin D deficiency in different studies[16,22–24]. We found two studies suggesting that postoperative PTH testing may help identify patients who are at risk of hypocalcemia.
Post-thyroidectomy hypocalcemia is a common complication that causes increased morbidity. This review aims to identify the factors that predict occurrence of hypocalcemia after total thyroidectomy in children and adolescents.
Comprehensive searches of English language pediatric (≤18 years of age) articles were performed in Medline, CINAHL, EMBASE, Web of Science and the Cochrane Library. Studies published between January 1, 1970 to August 20, 2020 regarding risk factors and strategies to prevent hypocalcemia were included if the study: 1. included only pediatric patients who were ≤18 years of age, 2. included only patients who had total, subtotal or completion thyroidectomy, 3. defined hypocalcemia as serum total calcium of <2.0 mmol/L (8 mg/dL) or ionized calcium of <1.0 mmol/L. The quality of included papers was assessed using the Newcastle-Ottawa scale. Results of all included studies were summarised. Meta-analyses were performed if appropriate.
Five studies with a total of 477 patients between 0 and 18 years, who had total/subtotal/completion thyroidectomy, were included. Overall rates of transient hypocalcemia were higher than permanent hypocalcemia (transient n = 104, 22%; permanent n = 48, 10%). Two studies found intraoperative parathyroid hormone (PTH) useful in predicting hypocalcemia. While two single institution cohort studies reported that neck dissection, male sex and a lower Parathyroid Gland Remaining In Situ score were associated with hypocalcemia, two other studies, including one population-based cohort study, reported that age at surgery, patient sex, hospital volume, type of thyroid disease, number of identified parathyroid glands, parathyroid auto-transplantation, operation time, thyroid specimen weight, and lymph node dissection were not risk factors for hypocalcemia.
Intraoperative PTH may be useful in predicting hypocalcemia in children after total thyroidectomy. No consistent clinical risk factors or preventative methods were identified in the pediatric literature. High-quality pediatric research is urgently required to address this knowledge gap.
Risk factors for postoperative hypocalcemia following total thyroidectomy: a retrospective study
2024, Annals of Saudi Medicine
Preoperative Vitamin.D Status and Post-Total Thyroidectomy Hypocalcemia
2024, Iranian Journal of Otorhinolaryngology
Does Vitamin D Deficiency Really Increase the Risk of Post-surgical Hypoparathyroidism?
2023, Indian Journal of Otolaryngology and Head and Neck Surgery
Serum Parathyroid Hormone and Vitamin D Levels as Predictors of Hypocalcemia after Total/ Near Total Thyroidectomy
2023, Indian Journal of Otolaryngology and Head and Neck Surgery

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Clinical surgery-InternationalThe impact of age, vitamin D3 level, and incidental parathyroidectomy on postoperative hypocalcemia after total or near total thyroidectomy

Abstract

Background

Patients

Results

Conclusions

Section snippets

Patients

Results

Comments

Am J Surg

J Am Coll Surg

Endocrinol Metab Clin North Am

Arch Gerontol Geriatr

Am J Surg

Am J Surg

Otolaryngol Head Neck Surg

Management of simple nodular goiter: current status and future perspectives

Endocr Rev

Management of the nontoxic multinodular goiter: a North American survey

J Clin Endocrinol Metab

Assessment of the morbidity and complications of total thyroidectomy

Arch Otolaryngol Head Neck Surg

Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany

World J Surg

Hypocalcemia after thyroidectomy

Arch Surg

Clinical surgery-International
The impact of age, vitamin D₃ level, and incidental parathyroidectomy on postoperative hypocalcemia after total or near total thyroidectomy