Do Low Preoperative Vitamin D Levels Reduce the Accuracy of Quick Parathyroid Hormone in Predicting Postthyroidectomy Hy
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ORIGINAL ARTICLE – ENDOCRINE TUMORS
Do Low Preoperative Vitamin D Levels Reduce the Accuracy of Quick Parathyroid Hormone in Predicting Postthyroidectomy Hypocalcemia? Brian Hung-Hin Lang, MS, FRACS1, Kai Pun Wong, MBBS, FRCS1, Benjamin J. Cowling, PhD2, Yuen Ki Fong, MBBS, MRCS1, Desmond Kwan-Kit Chan, MBBS, MRCS1, and Grace Kin-Yee Hung, MBBS, MRCS1 1
Division of Endocrine Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China; 2School of Public Health, The University of Hong Kong, Hong Kong SAR, China
ABSTRACT Background. Although some studies have suggested that low preoperative 25-hydroxyvitamin D (25-OHD) levels may increase the risk of hypocalcemia and decrease the accuracy of single quick parathyroid hormone in predicting hypocalcemia after total thyroidectomy, the literature remains scarce and inconsistent. Our study aimed to address these issues. Methods. Of the 281 consecutive patients who underwent a total/completion total thyroidectomy, 244 (86.8 %) did not require any oral calcium and/or calcitriol supplements (group 1), while 37 (13.2 %) did (group 2) at hospital discharge. 25-OHD level was checked 1 day before surgery, and postoperative quick parathyroid hormone (PTH) was checked at skin closure (PTH-SC). Postoperative serum calcium was checked regularly. Hypocalcemia was defined by the presence of symptoms or adjusted calcium of \1.90 mmol/L. Significant factors for hypocalcemia were determined by univariate and multivariate analyses. The accuracy of PTH-SC in predicting hypocalcemia was measured by area under a receiver operating characteristic curve (AUC), and the AUC of PTH-SC was compared between patients with preoperative 25-OHD \15 and C15 ng/mL via bootstrapping. Results. Preoperative 25-OHD level was not significantly different between groups 1 and 2 (13.1 vs. 12.5 ng/mL, p = 0.175). After adjusting for other significant factors, PTH-SC (odds ratio 2.49, 95 % confidence interval Ó The Author(s) 2012. This article is published with open access at Springerlink.com First Received: 2 June 2012; Published Online: 12 September 2012 B. H.-H. Lang, MS, FRACS e-mail: [email protected]
1.52–4.07, p \ 0.001) and parathyroid autotransplantation (odds ratio 3.23, 95 % confidence interval 1.22–8.60, p = 0.019) were the two independent factors for hypocalcemia. The AUC of PTH-SC was similar between those with 25-OHD \15 and C15 ng/mL (0.880 vs. 0.850, p = 0.61) Conclusions. Low 25-OHD was not a significant factor for hypocalcemia and did not lower the accuracy of quick PTH in predicting postthyroidectomy hypocalcemia.
Postoperative hypoparathyroidism leading to hypocalcemia is the one of the most frequent morbidities after total thyroidectomy with a reported incidence ranging 3–40 %.[1,2] Because potentially life-threatening hypocalcemia does not usually develop until 24–48 h after surgery, hypoparathyroidism is one of the major reasons for delaying hospital discharge and dissuading surgeons from ambulatory thyroid surgery.[3,4] To safely manage postoper
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