Preoperative Vitamin D Deficiency Is a Risk Factor for Postsurgical Hypoparathyroidism

  • Clin Thyroidol 2021;33:137–139.
  • Background
    • Hypoparathyroidism is a rare condition characterized by:
      • Absent or inappropriately low parathyroid hormone (PTH):
        • Resulting in hypocalcemia and hyperphosphatemia
    • The most common cause of hypoparathyroidism is:
      • Surgery-associated accidental removal, damage, or devascularization of the para‐ thyroid glands:
        • Accounting for up to 7.6% of thyroid surgeries
    • This cause of hypoparathyroidism can be divided into:
      • Transient:
        • Which resolves within 6 months after anterior neck surgery (75% of cases)
      • Permanent (chronic):
        • Which persists for ≥ 6 months after the surgery (25% of cases)
    • Several risk factors have been identified, including:
      • Total thyroidectomy
      • Substernal goiter localization
      • Lymph node dissection
      • Inexperienced surgeons
      • Previous neck surgery
      • Malabsorptive states
    • This systematic review and meta-analysis aimed to synthesize the best available evidence between the association of vitamin D deficiency and the risk of transient or permanent postsurgical hypoparathyroidism in patients who undergo thyroidectomy
  • Methods
    • This was a systematic review with meta-analysis limited to observational studies that follow the:
      • MOOSE (Meta-analyses Of Observational Studies in Epidemiology) guidelines
    • The inclusion criteria were:
      • Studies investigating the association of preoperative serum vitamin D (25-OHD) levels with the risk of postoperative hypoparathyroidism in patients who underwent thyroidectomy (whether partial or total)
    • A comprehensive literature search was conducted in MEDLINE (PubMed), Cochrane (CENTRAL), and Scopus to include all studies up to October 31, 2020
    • Additionally, gray literature was searched using the most relevant websites, and references in all selected studies were manually searched to identify additional eligible trials
    • Language of publication was restricted to English
    • Two investigators independently completed the primary search and extracted the data
    • For any discrepancies, a third researcher resolved the differences
    • The Newcastle–Ottawa scale was used for assessing the studies’ quality
    • Sensitivity and subgroup analysis were used to investigate confounding factors such as preoperative use of vitamin D and / or calcium supplements, thyroid pathology, type of surgery and surgeon’s volume, quality of studies, and study design
  • Results
    • All the studies included in this systematic review were published between 2009 and 2020
    • The qualitative analysis included 56 studies and the quantitative analysis 39 (22 prospective and 17 retro‐ spective)
    • A total of 755,585 participants (607,077 women) were analyzed
    • The sample size for each study ranged from 30 to 620,744 patients
    • Post-thyroidectomy patients with vitamin D deficiency (serum 25-OHD levels ≤ 20 ng/ml) or insufficiency (levels between 21 and 30 ng/ml) showed:
      • A higher risk of developing transient hypoparathyroidism:
        • As compared with patients with preoperative vitamin D sufficiency (serum 25-OHD levels > 30 ng/ml):
          • With high relative heterogeneity among studies (RR, 1.92; 95% CI, 1.50–2.45; I2, 85%)
        • These results remained statistically significant regardless of whether patients had mild (serum 25-OHD levels between 11 and 20 ng/ml [RR, 1.46; 95% CI, 1.10–1.94]) or severe (levels ≤ 10 ng/ml [RR, 1.98; 95% CI, 1.42–2.76]) vitamin D deficiency
    • Regarding permanent hypoparathyroidism:
      • There was an increased risk only in those with severe vitamin D deficiency (RR, 2.45; 95% CI, 1.30–4.63)
    • No differences were found in the subgroup analyses according to the type of study design or quality assessment
  • Conclusions
    • In this systematic review and meta-analysis, patients who underwent partial or total thyroidectomy and who had preoperative mild vitamin D deficiency or insufficiency were at increased risk for the development of transient postsurgical hypoparathyroidism
    • Furthermore, those with severe vitamin D deficiency are at increased risk for permanent hypoparathyroidism

#Arrangoiz #ParathyroidSurgeon #ThyroidSurgeon #ParathyroidExpert #ThyroidExpert #EndocrineSurgery #HeadandNeckSurgeon #PostThyroidectomyHypoparathyroidism #CASO #CenterforAdvancedSurgicalOncology

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