Vitamin D Deficiency Reduces Postthyroidectomy Protracted Hypoparathyroidism Risk. Is Gland Preconditioning Possible?

Area of Science:

• Endocrinology
• Surgical Complications
• Metabolic Bone Disease

Background:

• Post-thyroidectomy hypoparathyroidism (PT-hypoPTH) is a common complication, with most patients recovering parathyroid function (PFR) within a year.
• The physiological mechanisms influencing PFR remain unclear.
• Vitamin D deficiency (VDD) is a primary cause of secondary hyperparathyroidism, but its role in PFR after PT-hypoPTH is unstudied.

Purpose of the Study:

• To investigate the impact of preoperative VDD on PFR following total thyroidectomy.

Main Methods:

• Retrospective analysis of a prospectively maintained database of 397 patients undergoing total thyroidectomy (May 2014-June 2019).
• VDD defined as 25(OH)D < 20 mg/mL preoperatively.
• PT-hypoPTH defined as intact PTH < 14 pg/mL on postoperative day 1.
• Survival analysis and binary logistic regression used to assess VDD's effect on PFR.

Main Results:

• Rates of transient, protracted, and definite PT-hypoPTH were 32.9%, 15.1%, and 5.2%, respectively.
• Higher VDD rates were observed in the early-recovery PT-hypoPTH group (55.2% vs 31.5%; P = .01).
• Preoperative VDD correlated with faster PFR (19 vs 35 days; P = .03) and acted as a protective factor against protracted PT-hypoPTH (OR 0.47; P = .016).

Conclusions:

• Preoperative VDD may precondition parathyroid glands, potentially aiding PFR after thyroidectomy.
• Further basic research and prospective trials are necessary to elucidate mechanisms and optimize clinical management.