Post-Operative Permanent Hypoparathyroidism and Preoperative Vitamin D Prophylaxis

Abstract

Permanent hypoparathyroidism, a feared thyroidectomy complication, leads to significant patient morbidity, medical treatment, and monitoring. This study explores whether preoperative high-dose vitamin D loading decreases the incidence of permanent hypoparathyroidism. In a subgroup analysis, the study examines the predictive utility of day 1 parathyroid hormone (PTH) in permanent hypoparathyroidism. Patients (n = 150) were previously recruited in the VItamin D In Thyroidectomy (VIDIT) trial, a multicentre, randomised, double blind, placebo-controlled trial evaluating the role of 300,000 IU cholecalciferol administered orally a week before total thyroidectomy. Patients were contacted postoperatively beyond six months through a telephonic questionnaire. The primary outcome was permanent hypoparathyroidism, strictly defined as the need for activated vitamin D six months postoperatively. Out of 150 patients, 130 (86.7%) were contactable. Permanent hypoparathyroidism occurred in 11/130 (8.5%) patients, with a lower incidence of 5.3% (3/57) in the cholecalciferol group compared to 11% (8/73) in the placebo group; however, this was non-significant (p = 0.34). In a subgroup analysis, no relationship between day 1 PTH level and the incidence of permanent hypoparathyroidism was found (p ≥ 0.99). There was a lower rate of permanent hypoparathyroidism in the cholecalciferol group, which was not significant. The predictive utility of day 1 postoperative PTH levels may be limited to transient hypoparathyroidism.

Preoperative Vitamin D and Calcium Administration in Patients Undergoing Thyroidectomy: A Systematic Review and Meta‐analysis of Randomized Controlled Trials

“…According to a previous study, the incidence of permanent hypoparathyroidism, defined as PTH < 10 pg/mL at 1‐year postthyroidectomy, was 1.9%. Similar to our results, Kannan et al showed lower rates of permanent hypoparathyroidism in the intervention group compared to the control group, but there was no statistically significant difference 36 . However, we could not find studies in the literature that found opposing results.…”

“…Similar to our results, Kannan et al showed lower rates of permanent hypoparathyroidism in the intervention group compared to the control group, but there was no statistically significant difference. 36 However, we could not find studies in the literature that found opposing results. Therefore, we believe that preoperative calcium and vitamin D supply has no clinical significance on permanent hypoparathyroidism.…”

Significant role of 1,25-dihydroxyvitamin D on serum calcium levels after total thyroidectomy: a prospective cohort study

“…Hypoparathyroidism and hypocalcemia are well-documented consequences of thyroidectomy. The symptoms of hypoparathyroidism range from no symptoms to mild numbness and tingling, muscle spasms, tetany, seizures, life-threatening laryngospasm, and cardiac arrhythmias ( 1 , 2 ). These symptoms not only prolong the hospital stay but also lead to increased costs for additional testing and treatment ( 2 , 3 ).…”

“…Recently, the introduction of new intraoperative modalities aimed at preserving intraoperative parathyroid function has been reported ( 4 , 5 ). The literature also discusses using preoperative VD or calcium (Ca) supplementation ( 1 , 3 , 6 ), as well as various postoperative Ca management strategies ( 7 , 8 ), to address this issue. However, evidence supporting these interventions, including those involving natural and active VD (calcitriol or alfacalcidol), remains inconclusive ( 9 ).…”

“…PTH is crucial in regulating Ca concentrations, both directly and indirectly, by producing 1,25-dihydroxyvitamin D (1,25(OH) comprehensively investigated the effects of 1,25(OH) 2 D on Ca levels after total thyroidectomy.…”