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Impact of pre-operative serum 25-hydroxyvitamin D on post-operative serum calcium in patients undergoing total thyroidectomy for benign goitre: retrospective study of 246 patients

  • M Erlem (a1), N Klopp-Dutote (a1), A Biet-Hornstein (a1), V Strunski (a1) and C Page (a1)...
Abstract Objective:

To determine whether pre-operative serum 25-hydroxyvitamin D has an impact on post-operative parathyroid hormone and serum calcium levels in patients undergoing total thyroidectomy for benign goitre.


This single-centre, retrospective study comprised 246 unselected surgical patients who had undergone total thyroidectomy for bilateral, benign, multinodular goitre. The correlation between pre-operative serum 25-hydroxyvitamin D and post-operative serum parathyroid hormone and serum calcium was studied to determine whether low pre-operative serum 25-hydroxyvitamin D was predictive of post-operative hypocalcaemia.


Seventy-nine patients (32 per cent) had post-operative hypocalcaemia. Eighteen patients (7.32 per cent) experienced unintentional parathyroidectomy (1 parathyroid gland in 15 patients, 2 parathyroid glands in 3 patients). In univariate analysis, pre-operative serum 25-hydroxyvitamin D was not correlated with post-operative serum calcium (p = 0.69) or post-operative serum parathyroid hormone (p = 0.5804). Furthermore, in multivariate analysis, which took into account unintentional parathyroidectomy, no correlation was found (p = 0.33). Bilateral unintentional parathyroidectomy was statistically associated with post-operative hypocalcaemia (p = 0.032).


Pre-operative serum 25-hydroxyvitamin D did not appear to have any impact on post-operative serum calcium in patients undergoing total thyroidectomy for benign goitre.

Corresponding author
Address for correspondence: Dr Cyril Page, Service d'ORL et de chirurgie de la face et du cou, Centre Hospitalier Sud, 80054 Amiens Cedex, France E-mail:
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1 PageC, StrunskiV. Parathyroid risk in total thyroidectomy for bilateral, benign, multinodular goitre: report of 351 surgical cases. J Laryngol Otol 2007;121:237–41
2 NoureldineSI, GentherDJ, LopezM, AgrawalN, TufanoRP. Early predictors of hypocalcemia after total thyroidectomy: an analysis of 304 patients using a short-stay monitoring protocol. JAMA Otolaryngol Head Neck Surg 2014;140:1006–13
3 HessmanC, FieldsJ, SchumanE. Outpatient thyroidectomy: is it a safe and reasonable option? Am J Surg 2011;201:565–8
4 SnyderSK, HamidKS, RobersonCR, RaiSS, BossenAC, LuhJH et al. Outpatient thyroidectomy is safe and reasonable: experience with more than 1,000 planned outpatient procedures. J Am Coll Surg 2010;210:575–82, 582–4
5 TripathiM, KarwasraRK, ParshadS. Effect of preoperative vitamin D deficiency on postoperative hypocalcemia after thyroid surgery. Thyroid Res 2014;7:8
6 Al-KhatibT, AlthubaitiAM, AlthubaitiA, MosliHH, AlwasiahRO, BadawoodLM. Severe vitamin D deficiency: a significant predictor of early hypocalcemia after total thyroidectomy. Otolaryngol Head Neck Surg 2015;152:424–31
7 DíezM, VeraC, RatiaT, DiegoL, MendozaF, GuillamotP et al. Effect of vitamin D deficiency on hypocalcaemia after total thyroidectomy due to benign goitre [in Spanish]. Cir Esp 2013;91:250–6
8 Kirkby-BottJ, MarkogiannakisH, SkandarajahA, CowanM, FlemingB, PalazzoF. Preoperative vitamin D deficiency predicts postoperative hypocalcemia after total thyroidectomy. World J Surg 2011;35:324–30
9 ErbilY, BarbarosU, TemelB, TurkogluU, IşseverH, BozboraA et al. The impact of age, vitamin D(3) level, and incidental parathyroidectomy on postoperative hypocalcemia after total or near total thyroidectomy. Am J Surg 2009;197:439–46
10 ErbilY, BozboraA, OzbeyN, IsseverH, AralF, OzarmaganS et al. Predictive value of age and serum parathormone and vitamin D3 levels for postoperative hypocalcemia after total thyroidectomy for nontoxic multinodular goiter. Arch Surg 2007;142:1182–7
11 YamashitaH, NoguchiS, MurakamiT, UchinoS, WatanabeS, OhshimaA et al. Predictive risk factors for postoperative tetany in female patients with Graves' disease. J Am Coll Surg 2001;192:465–8
12 ChiaSH, WeismanRA, TieuD, KellyC, DillmannWH, OrloffLA. Prospective study of perioperative factors predicting hypocalcemia after thyroid and parathyroid surgery. Arch Otolaryngol Head Neck Surg 2006;132:41–5
13 FalconeTE, SteinDJ, JumailyJS, PearceEN, HolickMF, McAnenyDB et al. Correlating pre-operative vitamin D status with post-thyroidectomy hypocalcemia. Endocr Pract 2015;21:348–54
14 LangBH, WongKP, CowlingBJ, FongYK, ChanDK, HungGK. Do low preoperative vitamin D levels reduce the accuracy of quick parathyroid hormone in predicting postthyroidectomy hypocalcemia? Ann Surg Oncol 2013;20:739–45
15 SalingerEM, MooreJT. Perioperative indicators of hypocalcemia in total thyroidectomy: the role of vitamin D and parathyroid hormone. Am J Surg 2013;206:876–82
16 LandryCS, GrubbsEG, HernandezM, HuMI, HansenMO, LeeJE et al. Predictable criteria for selective, rather than routine, calcium supplementation following thyroidectomy. Arch Surg 2012;147:338–44
17 GriffinTP, MurphyMS, SheahanP. Vitamin D and risk of postoperative hypocalcemia after total thyroidectomy. JAMA Otolaryngol Head Neck Surg 2014;140:346–51
18 LeeGH, KuYH, KimHI, LeeMC, KimMJ. Vitamin D level is not a predictor of hypocalcemia after total thyroidectomy. Langenbecks Arch Surg 2015;400:617–22
19 DocimoG, ToloneS, PasqualiD, ConzoG, D'AlessandroA, CasalinoG et al. Role of pre and post-operative oral calcium and vitamin D supplements in prevention of hypocalcemia after total thyroidectomy. G Chir 2012;33:374–8
20 NemadeSV, RokadeVV, PathakNA, TiwariSS, SonkhedkarSJ. Comparison between perioperative treatment with calcium and with calcium and vitamin D in prevention of post thyroidectomy hypocalcemia. Indian J Otolaryngol Head Neck Surg 2014;66(suppl 1):214–19
21 RohJL, ParkCI. Routine oral calcium and vitamin D supplements for prevention of hypocalcemia after total thyroidectomy. Am J Surg 2006;192:675–8
22 AlhefdhiA, MazehH, ChenH. Role of postoperative vitamin D and/or calcium routine supplementation in preventing hypocalcemia after thyroidectomy: a systematic review and meta-analysis. Oncologist 2013;18:533–42
23 SanabriaA, DominguezLC, VegaV, OsorioC, DuarteD. Routine postoperative administration of vitamin D and calcium after total thyroidectomy: a meta-analysis. Int J Surg 2011;9:4651
24 WuJ, HarrisonB. Hypocalcemia after thyroidectomy: the need for improved definition. World Journal of Endocrine Surgery 2010;2:1720
25 HolickMF, BinkleyNC, Bischoff-FerrariHA, GordonCM, HanleyDA, HeaneyRP et al. Guidelines for preventing and treating vitamin D deficiency and insufficiency revisited. J Clin Endocrinol Metab 2012;97:1153–8
26 GellerJL, HuB, ReedS, MirochaJ, AdamsJS. Increase in bone mass after correction of vitamin D insufficiency in bisphosphonate-treated patients. Endocr Pract 2008;14:293–7
27 SchöttkerB, HaugU, SchomburgL, KöhrleJ, PernaL, MüllerH et al. Strong associations of 25-hydroxyvitamin D concentrations with all-cause, cardiovascular, cancer, and respiratory disease mortality in a large cohort study. Am J Clin Nutr 2013;97:782–93
28 WeaverS, DohertyDB, JimenezC, PerrierND. Peer-reviewed, evidence-based analysis of vitamin D and primary hyperparathyroidism. World J Surg 2009;33:2292–302
29 DurupD, JørgensenHL, ChristensenJ, SchwarzP, HeegaardAM, LindB. A reverse J-shaped association of all-cause mortality with serum 25-hydroxyvitamin D in general practice: the CopD study. J Clin Endocrinol Metab 2012;97:2644–52
30 DurupD, JørgensenHL, ChristensenJ, TjønnelandA, OlsenA, HalkjærJ et al. A reverse J-shaped association between serum 25-hydroxyvitamin D and cardiovascular disease mortality: the CopD study. J Clin Endocrinol Metab 2015;100:2339–46
31 SamAH, DhilloWS, DonaldsonM, MeeranK, TolleyNS, PalazzoFF. Serum parathyroid hormone is not an accurate predictor of postthyroidectomy hypocalcemia in vitamin D-deficient patients: a pilot study. Clin Chem 2011;57:1206–7
32 LangBH, WongKP, CheungCY, FongYK, ChanDK, HungGK. Does preoperative 25-hydroxyvitamin D status significantly affect the calcium kinetics after total thyroidectomy? World J Surg 2013;37:1592–8
33 HuangSM. Do we overtreat post-thyroidectomy hypocalcemia? World J Surg 2012;36:1503–8
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