Vitamin D and risk of postoperative hypocalcemia after total thyroidectomy

IMPORTANCE: Transient hypocalcemia is a well-recognized occurrence after total thyroidectomy. It has been hypothesized that underlying vitamin D deficiency may increase the risk of this complication, although to date there are few data in the literature supporting this hypothesis. OBJECTIVE: To investigate whether perioperative vitamin D levels have any effect on postthyroidectomy hypocalcemia. DESIGN, SETTING, AND PARTICIPANTS: We performed a retrospective review of a prospectively maintained database of thyroidectomies from November 1, 2009, through September 30, 2012, at an academic teaching hospital. The study included 121 patients with available vitamin D levels undergoing total or completion thyroidectomy. Patients with preexisting hypercalcemia or hyperparathyroidism were excluded. INTERVENTIONS: All patients underwent total removal of all thyroid tissue by a capsular dissection technique. Routine calcium or vitamin D supplementation was not administered. Biochemical hypocalcemia was defined as any single postoperative corrected calcium level less than 8.0mg/dL (to convert to millimoles per liter, multiply by 0.25) and symptomatic hypocalcemia as any symptoms of hypocalcemia. MAIN OUTCOMES AND MEASURES: Outcome measureswere incidence of postoperative hypocalcemia and association with vitamin D levels. A multivariate analysis was performed to study the effect of other variables, including performance of central neck dissection, incidental parathyroidectomy, and hyperthyroidism, on the incidence of postoperative hypocalcemia. RESULTS: The incidence of transient biochemical hypocalcemia was 24%(n = 29/121). There was no correlation between vitamin D levels and risk of postoperative hypocalcemia. On univariate analysis, performance of concomitant central compartment neck dissection revealed an increased risk of hypocalcemia (P = .06), but this finding was not significant on multivariate analysis. CONCLUSIONS AND RELEVANCE: Vitamin D levels do not appear to have a significant effect on the risk of postthyroidectomy hypocalcemia.