Falcone Todd E, Stein Daniel J, Jumaily Jeffrey S, Pearce Elizabeth N, Holick Michael F, McAneny David B, Jalisi Scharukh, Grillone Gregory A, Stone Michael D, Devaiah Anand K, Noordzij J Pieter
Endocr Pract. 2015 Apr;21(4):348-54. doi: 10.4158/EP14264.OR. Epub 2014 Dec 22.
To examine the relationship between pre-operative vitamin D status and post-thyroidectomy hypocalcemia.
Retrospective study examining 264 total and completion thyroidectomies conducted between 2007 and 2011. Subjects included had a recorded 25-hydroxyvitamin D (25[OH]D) level within 21 days prior to or 1 day following surgery, did not have a primary parathyroid gland disorder, and were not taking 1,25-dihydroxyvitamin D3 (calcitriol) prior to surgery. Some subjects were repleted with vitamin D pre-operatively if a low 25(OH)D level (typically below 20 ng/mL) was identified. Pre-operative 25(OH)D, concurrent neck dissection, integrity of parathyroid glands, final pathology, postoperative parathyroid hormone (PTH), calcium nadir and repletion, and length of stay were examined.
The mean pre-operative 25(OH)D for all subjects was 25 ng/mL, and the overall rate of post-operative hypocalcemia was 37.5%. Lower pre-operative 25(OH)D did not predict postoperative hypocalcemia (P = .96); however, it did predict the need for postoperative 1,25-dihydroxyvitamin D3 administration (P = .01). Lower postoperative PTH levels (P = .001) were associated with postoperative hypocalcemia.
Pre-operative 25(OH)D did not predict a postoperative decrease in serum calcium, although it did predict the need for 1,25-dihydroxyvitamin D3 therapy in hypocalcemic subjects. We recommend that 25(OH)D be assessed and, if indicated, repleted pre-operatively in patients undergoing total thyroidectomy.
研究术前维生素D状态与甲状腺切除术后低钙血症之间的关系。
回顾性研究2007年至2011年间进行的264例全甲状腺切除术和甲状腺次全切除术。纳入的受试者在手术前21天内或手术后1天有记录的25-羟维生素D（25[OH]D）水平，无原发性甲状旁腺疾病，且术前未服用1,25-二羟维生素D3（骨化三醇）。如果发现25(OH)D水平低（通常低于20 ng/mL），一些受试者在术前补充维生素D。检查术前25(OH)D、同期颈部淋巴结清扫、甲状旁腺完整性、最终病理、术后甲状旁腺激素（PTH）、血钙最低点及补充情况、住院时间。
所有受试者术前25(OH)D的平均水平为25 ng/mL，术后低钙血症的总体发生率为37.5%。术前较低的25(OH)D水平不能预测术后低钙血症（P = 0.96）；然而，它确实能预测术后补充1,25-二羟维生素D3的必要性（P = 0.01）。术后较低的PTH水平（P = 0.001）与术后低钙血症相关。
术前25(OH)D水平不能预测术后血清钙的降低，尽管它确实能预测低钙血症患者补充1,25-二羟维生素D3治疗的必要性。我们建议对接受全甲状腺切除术的患者术前评估25(OH)D水平，如有必要则进行补充。
