The utility of serum 25-hydroxyvitamin D in predicting post-thyroidectomy hypocalcemia in thyrotoxic subjects: a single-center cohort study

Authors

  • Poongkodi Karunakaran Department of Endocrine Surgery, Madras Medical College, Chennai, Tamil Nadu, India http://orcid.org/0000-0003-4854-0367
  • Deepak Thomas Abraham Department of Endocrine Surgery, Christian Medical College, Vellore, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-2902.isj20205359

Keywords:

Euthyroid, Hyperthyroidism, Postoperative hypocalcemia, Thyroidectomy, Thyrotoxicosis, 25-hydroxycholecalciferol, Vitamin D deficiency

Abstract

Background: The role of preoperative vitamin D deficiency as a predictor of post-thyroidectomy hypocalcemia in thyrotoxic subjects is controversially reported. This prospective cohort study determined the utility of serum 25-hydroxyvitamin D (25OHD) levels in predicting transient hypocalcemia in thyrotoxic and euthyroid patients undergoing total thyroidectomy (TT).

Methods: Subjects with new-onset hyperthyroidism (n=97; age=median (Inter-Quartile Range); 38 (18) years; M:F=25:72) and age; sex-matched euthyroid cohorts (n=231; age=37 (18) years; M:F=40:191) undergoing TT were evaluated for serum corrected-calcium, intact parathormone and 25OHD levels at baseline, 48-hour and 6-months post-TT, p value <0.05 was considered significant.

Results: The incidence of transient hypocalcemia in thyrotoxic subjects was 58.8% (57/97) versus 22.5% (52/179) in euthyroid cohorts. In receiver operating characteristic analysis predicting transient hypocalcemia for the test-variable preoperative 25OHD, the area under curve (AUC) among euthyroid subjects was 0.725 (95% CI: 0.641-0.809; p<0.001) with a threshold of 17.6 ng/mL with sensitivity and specificity of 65.4% and 64.2% respectively. In thyrotoxic subjects, the AUC was 0.573 (95% CI; 0.452-0.694; p=0.222) with poorer predictability and was less than that of euthyroid subjects.

Conclusions: Preoperative 25OHD below 17.6 ng/ml was reliable in predicting transient postoperative hypocalcemia in euthyroid subjects though with a limited sensitivity and specificity but unreliable in thyrotoxic subjects undergoing TT.

Author Biographies

Poongkodi Karunakaran, Department of Endocrine Surgery, Madras Medical College, Chennai, Tamil Nadu, India

Civil Surgeon and Assistant Professor of Endocrine Surgery, Department of Endocrine surgery

Deepak Thomas Abraham, Department of Endocrine Surgery, Christian Medical College, Vellore, Tamil Nadu, India

Professor and Head, Department Of Endocrine Surgery

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Published

2020-11-27

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Original Research Articles