Post-Operative Permanent Hypoparathyroidism and Preoperative Vitamin D Prophylaxis

• Main Authors: Tara Kannan, Yasmin Foster, David J. Ho, Scott J. Gelzinnis, Michael Merakis, Zsolt J. Balogh, Katie Wynne, Cino Bendinelli
• Format: Article
• Language: English
• Published: MDPI AG 2021-01-01
• Series: Journal of Clinical Medicine
• Subjects: permanent hypoparathyroidism; postoperative hypocalcaemia; thyroidectomy; preoperative vitamin D
• Online Access: https://www.mdpi.com/2077-0383/10/3/442

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 (<i>n</i> = 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 (<i>p</i> = 0.34). In a subgroup analysis, no relationship between day 1 PTH level and the incidence of permanent hypoparathyroidism was found (<i>p</i> ≥ 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.