Preoperative vitamin D deficiency and postoperative hypocalcemia in thyroid cancer patients undergoing total thyroidectomy plus central compartment neck dissection

Abstract

Background: There appears to be a lack of consensus whether preoperative vitamin D deficiency (VDD) increases the risk of postoperative hypocalcemia and decreases the accuracy of postoperative parathyroid hormone (PTH) in predicting hypocalcemia in thyroid cancer patients undergoing total thyroidectomy (TT) plus central compartment neck dissection (CCND). This study aims to address these issues.

Method: All consecutive thyroid cancer patients who underwent TT plus CCND were retrospectively reviewed through a prospectively collected database between October 2015 and April 2016 in a tertiary referral hospital. The multivariate analysis was performed to identify the significant predictors for hypocalcemia. Receiver operator characteristic curve (ROC) was created and the area under the ROC was used to evaluate the predictive accuracy of postoperative PTH and compared between patients with or without VDD.

Results: A total of 186 patients were included. The incidence of VDD was 73.7% (137 patients). The incidence of biochemical and symptomatic hypocalcemia was similar in patients with or without VDD (P = 0.304 and 0.657, respectively). Multivariate analysis showed that only postoperative PTH was an independent predictor of symptomatic hypocalcemia (OR = 8.05, 95%CI = 3.99-16.22; P = 0.000). The area under the ROC was similar between patients with preoperative vitamin D level < 20 and ≥20 ng/mL (0.809 versus 0.845, P = 0.592).

Conclusion: VDD was not a significant risk factor for hypocalcemia following TT+CCND, and did not affect the accuracy of postoperative PTH as a predictor of postoperative hypocalcemia. Thus, routine preoperative screening for vitamin D seems to be unnecessary.