Published: 2019-12-26

Correlation of pre-operative vitamin D3 levels with post-operative hypocalcemia in patients undergoing total thyroidectomy

Mallikarjuna M. N., Arun Kumar, Ramya M. V., Santhosh C. S.


Background: Total thyroidectomy (TT) is a commonly performed procedure for various  thyroid disorders, with parathyroid insufficiency manifesting as hypocalcaemia being a well-known complication. Albeit, vitamin D is well implicated in calcium homeostasis, the association between hypovitaminosis D and postoperative hypocalcaemia is yet to be concluded. The aim of our study is to evaluate the correlation of preoperative serum vitamin D3 levels  with occurrence of post-operative hypocalcemia in patients undergoing TT.

Methods: A prospective  study  was conducted on 50 patients  undergoing TT for benign thyroid diseases from November 2016 to May 2018. Pre-operative vitamin D3 levels were estimated. Serum calcium levels was measured pre‑ and post‑operatively at 24hours, 1st week and 4th week. Serum calcium level ≤8.5 mg/dl was considered as biochemical hypocalcemia. A data of demographic, clinical, biochemical and intraoperative findings were documented and analysed.

Results: Statically 14 (28%) patients developed symptomatic hypocalcemia. Out of these, 11 (78.5%) patients had preoperative vitamin D levels of <30 ng/dl (p=0.034). 24 hours postoperative serum calcium level was significantly  lesser in patients with  lower preoperative vitamin D levels (p=0.015), suggesting that postoperative  hypocalcemia (24 hr) is statistically related to pre-operative vitamin D3 levels.

Conclusions: It could be concluded from our study that preoperative serum vitamin D3 levels can predict post-operative occurrence of symptomatic and/or biochemical hypocalcemia. Thus, it could be hypothesized that supplementing vitamin D preoperatively could curb the incidence of hypocalcaemia following TT. However, further relevant trials are needed to attest to this.



Postoperative hypocalcemia, Serum vitamin D3, Total thyroidectomy

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Williams NS, Christopher JK, Bulstrode P. Ronan O’Connell. The thyroid and parathyroid glands, bailey and love, short practice of surgery. Page 762, Chapter 51, 26th edition.

Lal G, Clark OH. Thyroid, parathyroid and adrenal. Schwartz’s principles of surgery. 8th ed. New York (NY): McGraw-Hill; 2005:1395-1470.

Bergamaschi R, Becouarn G, Ronceray J, Arnaud JP. Morbidity of thyroid surgery. Am J Surg. 1998;176:71-5.

Bhattacharyya N, Fried MP. Assessment of the morbidity and complications of total thyroidectomy. Arch Otolaryngol Head Neck Surg. 2002;128:389-92.

Sanguinetti A, Docimo G, Ragusa M, Calzolari F, D Ajello F, Ruggiero R. Ultrasound scissors versus electrocautery in axillary dissection: our experience. G Chir. 2010;31(4):151-3.

Cirocchi R, Boselli C, Guarino S, Sanguinetti A, Trastulli S, Desiderio J, et al. Total thyroidectomy with ultrasonic dissector for cancer: multicentric experience. World J Surg Oncol. 2012;10(1):70.

Baldassarre RL, Chang DC, Brumund KT, Bouvet M. Predictors of hypocalcemia after thyroidectomy: results from the nationwide inpatient sample. ISRN Surg. 2012;2012.

Spanknebel K, Chabot JA, DiGiorgi M, Cheung K, Curty J, Allendorf J, et al. Thyroidectomy using monitored local or conventional general anesthesia: an analysis of outpatient surgery, outcome and cost in 1,194 consecutive cases. World J Surg. 2006;30(5):813-24.

Snyder SK, Hamid KS. Outpatient thyroidectomy is safe and reasonable: experience with more than 1,000 planned outpatient procedures. J Am Coll Surg. 2010;210(5):575-82.

Seybt MW, Terris DJ. Outpatient thyroidectomy: experience in over 200 patients. Laryngo. 2010;120(5):959-63.

Wu G, Pai SI, Agrawal N, Richmon J, Dackiw A, Tufano RP. Profile of patients with completion thyroidectomy and assessment of their suitability for outpatient surgery. Otolaryngol Head Neck Surg. 2011;145(5):727-31.

Houlton JJ, Pechter W, Steward DL. PACU PTH facilitates safe outpatient total thyroidectomy. Otolaryngol Head Neck Surg. 2011;144(1):43-7.

Hickey L, Gordon CM. Vitamin D deficiency: new perpectives on an old disease. Curr Opin Endocrinol Metab. 2004;11:18-25.

Balesaria S, Sangha S, Walters JRF. Human duodenum responses to vitamin D metabolites of TRPV6 and other genes involved in calcium absorption. Am J Physiol Gastrointest Liver Physiol. 2009;297(6):1193-7.

Tartaglia F, Giuliani A, Sguelia M, Biancari F, Juvonen T, Campana FP. Randomized study on oral administration of calcitriol to prevent symptomatic hypocalcemia after total thyroidectomy. Am J Surg. 2005;190:424-9.

Kirkby-Bott J, Markogiannakis H, Skandarajah A, Cowan M, Fleming B, Palazzo F. Preoperative Vitamin D deficiency predicts postoperative hypocalcaemia after total thyroidectomy. World J Surg. 2011;35:324-30.

de Roy van Zuidewijn DB, Songun I, Kievit J, van de Velde CJ. Complications of thyroid surgery. Ann Surg Oncol. 1995;2:56‑60.

Tripathi M, Karwasra RK, Parshad S. Effect of preoperative vitamin D deficiency on postoperative hypocalcemia after thyroid surgery. Thyroid Res. 2014;7(1):8.

Al-Khatib T, Althubaiti AM, Severe vitamin D deficiency: a significant predictor of early hypocalcemia after total thyroidectomy. Otolaryngol Head Neck Surg. 2015;152(3):424-31.

Edafe O, Antakia R. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg. 2014;101(4):307-20.

Zahedi Niaki N, Singh H, Moubayed SP, Leboeuf R, Tabet JC, Christopoulos A, et al. The Cost of Prolonged Hospitalization due to Post thyroidectomy Hypocalcemia: a case-control study. Adv Endocrinol. 2014;2014.