Evaluation of High Dose Preoperative Activated Vitamin D to Prevent Post Total Thyroidectomy Hypocalcemia

Abstract Background With increase in the number of thyroidectomies, the incidence of postoperative hypocalcemia has seen a rise as well. Deficiency of vitamin D has long been debated as a risk factor for post thyroidectomy hypocalcemia. The advantage of using vitamin D as a predictor for postoperative hypocalcemia may be (i) easy to estimate (ii) any deficiency can be easily corrected. Objective To determine the effectiveness of preoperative high dose calcitriol supplementation in reducing hypocalcemia following total thyroidectomy. Patients and Methods to assess the effect of preoperative vitamin D3 deficiency on post thyroidectomy hypocalcemia. For that purpose, 40 Egyptian patients for whom total thyroidectomy was performed in general surgery department at El-demerdash and Ain Shams University Specialized Hospital form March 2020 to September 2020. Patients were divided into 2 Groups; Group 1 included patients receiving preoperative single oral dose of active vit D(300000 IU) and Group 2 included patients receiving placebo instead of vit D. The incidence of postoperative hypocalcemia was investigated in all patients. Results Preoperative vitamin D measurements revealed a deficiency prevalence of 66.7% and a mean Vitamin D level of 17.09 ± 6.01. The main findings of the current study as regards to calcium was that the mean preoperative level of calcium was 9.61 ± 0.48 mg/dl, the lowest level of postoperative calcium was detected after 48 hours and 72 hours. With respect to relation between calcium and preoperative vitamin D, the results showed that there is no big difference between two groups (hypocalcemia occurred in 30% from patients in vit D group and 35% in placebo group) and no patients with normal preoperative vitamin D had a postoperative hypocalcemia 24, 48 or 72 hours after the operation. Conclusion Giving of single preoperative high dose vitamin D doesn’t reduce the overall rate of hypocalcemia after total thyroidectomy. Postoperative hypocalcemia is closely related to the preoperative vitamin D level and patients with hypovitaminosis D are more labile to develop hypocalcemia.

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Assessment of Effect of Preoperative Vitamin D Deficiency on Postoperative Hypocalcemia after Total Thyroidectomy, A Prospective Study

QJM ◽

10.1093/qjmed/hcaa050.045 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M S Farahat ◽

H M Omran ◽

R F Abbas ◽

A A A Ghida

Keyword(s):

Vitamin D ◽

Total Thyroidectomy ◽

Vitamin D Deficiency ◽

Hypovitaminosis D ◽

University Hospital ◽

Postoperative Hypocalcemia ◽

Vitamin D Levels ◽

A Prospective Study ◽

Surgery Department ◽

Postoperative Hypocalcaemia

Abstract Background One-day surgeries are routinely performed for hemithyroidectomy, but hospital stay duration is more controversial after total thyroidectomy due to postoperative, potentially life-threatening complications. Aim of the Work The aim of this study is to assess the effect of pre-operative vitamin D3 deficiency on post thyroidectomy hypocalcemia. Patients and Methods Type of Study: This was a prospective cohort study which included 60 Egyptian patients for whom total thyroidectomy had been performed. Study Setting: Patients were recruited from general surgery department at Kafr Elshiekh University Hospital and Ain Shams University Hospital. Study Period: The study duration was form April 2018 to October 2018. Results The main findings of the current study as regards to calcium was that the mean preoperative level of calcium was 9.61 ± 0.48 mg/dl, the lowest level of postoperative calcium was detected after 48 hours (9.03 ± 0.73) and the highest postoperative level was measured 12 hours after the operation. With respect to relation between calcium and preoperative vitamin D, the results showed that no patients with normal preoperative vitamin D had a postoperative hypocalcaemia 12, 24, 48 or 72 hours after the operation. After one month, however, 2 patients with normal preoperative vitamin D level, had hypocalcaemia. It worth mention that these two patients had border line normal preoperative vitamin D level. The percentage of patients with low preoperative vitamin D level who had postoperative hypocalcaemia was 5%, 5%, 25% and 15% after the operation by 12, 24, 48 and 72 hours respectively while after one month, the percentage was 10%. The differences between hypocalcaemia incidence between patients with normal and below normal vitamin D levels was statistically significant although it was a borderline significance. The sensitivity and specificity of preoperative vitamin D level in prediction of postoperative hypocalcaemia was 87.50% and 40.91% respectively. Conclusion After investigating the postoperative calcium level in patients with and without preoperative vitamin D deficiency, the study had the following conclusions: Vitamin D deficiency is significantly common among Egyptian population, postoperative hypocalcaemia is closely related to the preoperative vitamin D level and patients with hypovitaminosis D are more labile to hypocalcaemia and females are more likely to have postoperative hypocalcemia.

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Vitamin D Deficiency as a Predictive Factor of Transient Hypocalcemia after Total Thyroidectomy

International Journal of Endocrinology ◽

10.1155/2020/8875257 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

A. Bove ◽

C. Dei Rocini ◽

R. M. Di Renzo ◽

M. Farrukh ◽

G. Palone ◽

...

Keyword(s):

Vitamin D ◽

Total Thyroidectomy ◽

Vitamin D Deficiency ◽

Serum Calcium ◽

Predictive Factor ◽

Postoperative Hypocalcemia ◽

Independent Predictive Factor ◽

Preoperative Serum ◽

Group 2 ◽

Group 1

Background. Total thyroidectomy (TT) is recommended in the treatment of malignant and benignant thyroid diseases, and, to date, transient hypocalcemia is the most frequent complication after the procedure. We prospectively evaluated the role of vitamin D deficiency as a predictor of postoperative hypocalcemia. Methods. This is a prospective cohort study which was conducted between January 2016 and April 2019. A total of 177 consecutive patients (141 (79.7%) women and 36 (20.3%) men) who underwent TT were included in the current study. Hypocalcemia occurred when serum calcium levels were below 8.0 mg/dL or 1.10 mmol/L. Patients were divided into two groups (Group 1, normocalcemic; Group 2, hypocalcemic) and were assessed taking into consideration preoperative serum 25-hydroxy vitamin D (25-OHD) levels, preoperative serum calcium levels, thyroid hormone levels, sex, body mass index (BMI), and smoking habits. Vitamin D deficiency was defined as 25-OHD levels <25 ng/mL. Results. The incidence of postoperative asymptomatic and symptomatic hypocalcemia in the two groups was 19.8% and 15.8%, respectively. Preoperative 25-OHD level was significantly different between Group 1 and Group 2 (31.5 ± 15.0 ng/mL vs 18.7 ± 9.8 ng/mL,p=0.017). Logistic regression analysis revealed that preoperative vitamin D deficiency was a significant predictive factor of postoperative hypocalcemia (p=0.012), and, specifically, the risk of hypocalcemia increased 15-fold in patients with a preoperative vitamin D level <25 ng/mL (odds ratio [OR], 14.8). Conclusions. Postoperative hypocalcemia is significantly associated with low preoperative levels of serum 25-OHD. Our studies demonstrate that vitamin D deficiency (<25 ng/mL) is an independent predictive factor of postoperative hypocalcemia.

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The impact of postoperative percent change of parathormone level from baseline value on the rate of hypocalcemia after total thyroidectomy

International Surgery ◽

10.9738/intsurg-d-16-00249.1 ◽

2017 ◽

Author(s):

Ismail Cem Sormaz ◽

Ahmet Yalin Iscan ◽

Ilker Ozgur ◽

Seyma Karakus ◽

Fatih Tunca ◽

...

Keyword(s):

Total Thyroidectomy ◽

Albumin Concentration ◽

Postoperative Hypocalcemia ◽

Percent Change ◽

Number Of Patients ◽

Increased Risk ◽

Symptomatic Hypocalcemia ◽

Postoperative Serum ◽

Group 2 ◽

The Impact

Background: To investigate the impact of the percent change of postoperative parathormone (PoPTH) level from baseline value (∆PTH) on the rate of hypocalcemia after total thyroidectomy. Methods: Assays of serum PTH and calcium (Ca) were performed preoperatively and at 24 hours postoperatively in 222 consecutive patients who underwent total thyroidectomy. Postoperative hypocalcemia was defined as serum calcium level corrected for albumin concentration (cCa) <8.5mg/dl. Patients with postoperative hypocalcemia were classified as group1 (n=100) and those with normal Ca levels as group 2 (n=122). The PoPTH levels and ∆PTH were compared between the two groups. ROC analysis was performed to determine the cut off values for PoPTH and ∆PTH. Results: The mean PoPTH level was significantly lower in group 1 compared to group 2 (18.6±15.3 pg/ml vs 32.3±15.6 pg/ml, respectively; P<0.0001). PoPTH values were within normal range in 54% of the patients with hypocalcemia and 35% of those with symptomatic hypocalcemia. PoPTH <28pg/ml or ∆PTH >45 were significantly associated with increased risk of post-thyroidectomy hypocalcemia (P=0.0001). A ∆PTH >70% ,PoPTH ≤ 15.5pg/ml and postoperative serum cCa concentrations<8.0mg/dl significantly predicted symptomatic hypocalcemia(P=0.009;P=0.006;andP=0.0001;respevtively).The sensitivities of ∆PTH,PoPTH level and postoperative serum cCa concentration to predict symptomatic hypocalcemia were 67%,64% and100, respectively. Conclusion: Although, PTH decline significantly correlate with symptomatic hypocalcemia, a considerable number of patients may experience hypocalcemic symptoms in spite of normal PoPTH levels. Analysis of serum Ca concentrations at 24 hours postoperatively help to achieve a more precise prediction of patients who bear a high risk for developing hypocalcemic symptoms.

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Determinants of postoperative hypocalcemia in vitamin D–deficient Graves’ patients after total thyroidectomy

The American Journal of Surgery ◽

10.1016/j.amjsurg.2010.04.030 ◽

2011 ◽

Vol 201 (5) ◽

pp. 685-691 ◽

Cited By ~ 25

Author(s):

Yeşim Erbil ◽

Nese Colak Ozbey ◽

Serkan Sari ◽

Haluk Recai Unalp ◽

Orhan Agcaoglu ◽

...

Keyword(s):

Vitamin D ◽

Total Thyroidectomy ◽

Postoperative Hypocalcemia

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EFFECT OF HIGH-DOSE VITAMIN D REPLETION ON GLYCEMIC CONTROL IN AFRICAN-AMERICAN MALES WITH PREDIABETES AND HYPOVITAMINOSIS D

Endocrine Practice ◽

10.4158/ep14548.or ◽

2015 ◽

Vol 21 (6) ◽

pp. 604-612 ◽

Cited By ~ 27

Author(s):

Elena Barengolts ◽

Buvana Manickam ◽

Yuval Eisenberg ◽

Arfana Akbar ◽

Subhash Kukreja ◽

...

Keyword(s):

Vitamin D ◽

African American ◽

Glycemic Control ◽

African American Males ◽

Hypovitaminosis D ◽

High Dose ◽

High Dose Vitamin

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High-Dose Vitamin D Supplementation in People With Prediabetes and Hypovitaminosis D

Diabetes Care ◽

10.2337/dc12-1204 ◽

2012 ◽

Vol 36 (2) ◽

pp. 260-266 ◽

Cited By ~ 118

Author(s):

M. B. Davidson ◽

P. Duran ◽

M. L. Lee ◽

T. C. Friedman

Keyword(s):

Vitamin D ◽

Hypovitaminosis D ◽

Vitamin D Supplementation ◽

High Dose ◽

High Dose Vitamin

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Effect of vitamin D supplementation during pregnancy on neonatal mineral homeostasis and anthropometry of the newborn and infant

British Journal Of Nutrition ◽

10.1017/s0007114511006246 ◽

2012 ◽

Vol 108 (6) ◽

pp. 1052-1058 ◽

Cited By ~ 62

Author(s):

Pramila Kalra ◽

Vinita Das ◽

Anjoo Agarwal ◽

Mala Kumar ◽

V. Ramesh ◽

...

Keyword(s):

Vitamin D ◽

Usual Care ◽

Head Circumference ◽

Usual Care Group ◽

Hypovitaminosis D ◽

Vitamin D Supplementation ◽

Care Group ◽

Randomised Study ◽

Group 2 ◽

Group 1

Hypovitaminosis D is common in India. In the present prospective partially randomised study of vitamin D (D3) supplementation during pregnancy, subjects were randomised in the second trimester to receive either one oral dose of 1500 μg vitamin D3(group 1,n48) or two doses of 3000 μg vitamin D3each in the second and third trimesters (group 2,n49). Maternal 25-hydroxyvitamin D (25(OH)D) at term, cord blood (CB) alkaline phosphatase (ALP), neonatal serum Ca and anthropometry were measured in these subjects and in forty-three non-supplemented mother–infant pairs (usual care). Median maternal 25(OH)D at term was higher in group 2 (58·7, interquartile range (IQR) 38·4–89·4 nmol/l)v. group 1 (26·2, IQR 17·7–57·7 nmol/l) and usual-care group (39·2, IQR 21·2–73·4 nmol/l) (P = 0·000). CB ALP was increased (>8.02 μkat/l or >480 IU/l) in 66·7 % of the usual-care groupv. 41·9 % of group 1 and 38·9 % of group 2 (P = 0·03). Neonatal Ca and CB 25(OH)D did not differ significantly in the three groups. Birth weight, length and head circumference were greater and the anterior fontanelle was smaller in groups 1 and 2 (3·08 and 3·03 kg, 50·3 and 50·1 cm, 34·5 and 34·4 cm, 2·6 and 2·5 cm, respectively)v. usual care (2·77 kg, 49·4, 33·6, 3·3 cm;P = 0·000 for length, head circumference and fontanelle andP = 0·003 for weight). These differences were still evident at 9 months. We conclude that both 1500 μg and two doses of 3000 μg vitamin D3had a beneficial effect on infant anthropometry, the larger dose also improving CB ALP and maternal 25(OH)D.

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High-dose versus low-dose ergocalciferol for correcting hypovitaminosis D after fragility hip fracture: A randomized controlled trial

10.21203/rs.3.rs-47838/v2 ◽

2020 ◽

Author(s):

Atthakorn Jarusriwanna ◽

Suchat Phusunti ◽

Pojchong Chotiyarnwong ◽

Aasis Unnanuntana

Keyword(s):

Vitamin D ◽

Hip Fracture ◽

Dose Group ◽

Low Dose ◽

Hypovitaminosis D ◽

Optimal Level ◽

Vitamin D Supplementation ◽

High Dose ◽

Vitamin D2 ◽

Fragility Hip Fracture

Abstract Background: Hypovitaminosis D can be observed in most fragility hip fracture patients. However, measurement of 25-hydroxyvitamin D [25(OH)D] level is costly and may not be available in some centers. Without the baseline 25(OH)D level, the appropriate dose of vitamin D supplementation is not known. The aim of this study was to evaluate the effectiveness and safety of vitamin D supplementation in fragility hip fracture patients compared between high- and low-dose vitamin D supplementation. Methods: A total of 140 patients diagnosed with fragility hip fracture were randomly allocated to either the high-dose (60,000 IU/week) or low-dose (20,000 IU/week) vitamin D2 supplementation group for 12 weeks. The number of patients who achieved optimal vitamin D level [25(OH)D level > 30 ng/mL], the proportion of patients who developed hypercalcemia, and the functional outcome were compared between groups. Results: Of the 140 patients who were enrolled, 21 patients were lost to follow-up during the study period. The remaining 119 patients (58 and 61 in the high- and low-dose group, respectively) were included in the final analysis. The high-dose group had a higher rate of serum 25(OH)D restoration to optimal level than the low-dose group (82.8% vs 52.5%, respectively; p <0.001). Approximately 3.4% and 1.6% of patients in the high- and low-dose groups, respectively, had mild hypercalcemia, but none developed moderate, severe, or symptomatic hypercalcemia. There were no differences in functional outcome scores between groups.Conclusions: In treatment settings where baseline serum 25(OH)D level can’t be evaluated, we recommend high-dose vitamin D2 of approximately 60,000 IU/week for 12 weeks, with subsequent switch to a maintenance dose. This regimen effectively restored serum vitamin D to an optimal level in 82.8% of patients without causing symptomatic hypercalcemia.Trial registration: The protocol of this study was retrospectively registered in the Thai Clinical Trials Registry database no. TCTR20180302007 on 20 February 2018.

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The Effect of Vitamin D Supplementation on The Outcome of Treatment with Bevacizumab in Diabetic Macular Edema: A Randomized Clinical Trial

10.21203/rs.3.rs-920607/v1 ◽

2021 ◽

Author(s):

Sahba Fekri ◽

Masoud Soheilian ◽

Sepehr Roozdar ◽

Seyed-Hossein Abtahi ◽

Hosein Nouri

Keyword(s):

Vitamin D ◽

Visual Acuity ◽

Macular Edema ◽

Vitamin D Deficiency ◽

Diabetic Macular Edema ◽

Serum Vitamin ◽

Hypovitaminosis D ◽

Vitamin D Supplementation ◽

Vitamin D Levels ◽

Group 2

Abstract Purpose: Concomitant vitamin D deficiency (VDD) is speculated to aggravate diabetic macular edema (DME). We aimed to determine the effect of hypovitaminosis D correction on the outcome of treatment with intravitreal bevacizumab (IVB) in DME eyes.Methods: 83 eyes of 83 patients with DME were recruited and divided into three groups: normal vitamin D levels + IVB administration (Group 1 ), vitamin D insufficient/deficient + IVB administration (Group 2), and vitamin D insufficient/deficient + IVB administration+ oral vitamin D supplementation (Group 3). Visual (corrected distance visual acuity, CDVA) and anatomical (central macular thickness, CMT) outcomes of intervention were evaluated 1, 3, and 6 months after the triple IVB injections were completed. Serum vitamin D levels were measured 1 and 6 months after the third IVB administration. Results: In months 1, 3, and 6, after the basic triple IVB injection, visual acuity and CMT improved in all three groups, but improvements (both functional and anatomical) in groups 1 and 3 (sufficient vitamin D and corrected hypovitaminosis D) in month 6 were more significant than in group 2 (uncorrected hypovitaminosis D) (p <0.001). The mean number of IVB injections during follow-up was 5.33 (range: 4-7), which did not differ between the groups.Conclusion: Correction of vitamin D deficiency in DME patients with type 2 diabetes and vitamin D deficiency, in addition to IVB injections, may play a role in improving CDVA and CMT. However, this beneficial effect seems to be delayed by several months.Trial registration: Iranian Registry of Clinical Trials (IRCT), IRCT20200407046978N1, registered on April 11, 2020, - retrospectively registered. https://en.irct.ir/trial/46999

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Can Parathormon Levels after Ipsilateral Lobectomy Predict Postoperative Hypocalcemia in Patients Undergoing Total Thyroidectomy?

The American Surgeon ◽

10.1177/000313481708300433 ◽

2017 ◽

Vol 83 (4) ◽

pp. 421-427 ◽

Cited By ~ 1

Author(s):

Fatih Kul ◽

Turkay Kirdak ◽

Pinar Sarkut ◽

Gokhan Ocakoglu ◽

Nusret Korun

Keyword(s):

Total Thyroidectomy ◽

Side Group ◽

Total Calcium ◽

Postoperative Hypocalcemia ◽

Median Percentage ◽

Serum Total Calcium ◽

Group 2 ◽

Serum Pth ◽

The Relationship ◽

Group 1

The purpose of this study was to investigate the relationship between the serum parathormone (PTH) levels measured after completion of hemithyroidectomy on the first side during total thyroidectomy and the postoperative hypocalcemia. The patients were divided into two groups, as those who demonstrated a decrease in PTH levels measured after completion of hemithyroidectomy of the first side (Group 1, n = 43) and those who did not demonstrate a decrease in PTH levels (Group 2, n = 24). The serum PTH levels were measured just before the incision (PTHi), when the hemithyroidectomy stage had been completed (PTHht), at the end of the operation (PTHtt), and at the postoperative 24th hour (PTH24hr). The serum total calcium (Ca21) levels were also measured. The median percentage differences in PTHtt levels based on basal PTHi levels of Groups 1 and 2 were -60.6 and -15.7 per cent, respectively, P = 0.001. The frequency of postoperative biochemical hypocalcemia was higher in Group 1, P < 0.05. It was determined that a 10 per cent or higher decrease in PTHht levels in Group 1 could predict biochemical hypocalcemia at the postoperative 24th hour. In conclusions, postoperative hypocalcemia is seen more frequent in patients with a decrease of PTHht during total thyroidectomy. A decrease of 10 per cent in PTHht levels measured after ipsilateral lobectomy and a 62 per cent or higher decrease in PTHtt levels measured in the end of the total thyroidectomy could be helpful for prediction of postoperative hypocalcemia in these patients.

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