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

Erbil, Yeşim; Barbaros, Umut; Temel, Berna; Turkoglu, Umit; İşsever, Halim; Bozbora, Alp; Özarmağan, Selçuk; Tezelman, Serdar

doi:10.1016/j.amjsurg.2008.01.032

« Previous Next »The American Journal of Surgery
Volume 197, Issue 4 , Pages 439-446, April 2009

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

Yeşim Erbil, M.D.
- Department of General Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
- Corresponding author. Tel.: +90 212 5331784; fax: +90 212 6319771
Umut Barbaros, M.D.
- Department of General Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
Berna Temel, M.D.
- Department of Endocrinology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
Umit Turkoglu, M.D.
- Department of Biochemistry, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
Halim İşsever, Ph.D.
- Department of Health Public, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
Alp Bozbora, M.D.
- Department of General Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
Selçuk Özarmağan, M.D.
- Department of General Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
Serdar Tezelman, M.D.
- Department of General Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey

Received 23 November 2007; received in revised form 4 January 2008

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.

Keywords: Hypocalcemia, Total thyroidectomy, Incidental parathyroidectomy, Vitamin D