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

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.

Download Full-text

Effect of vitamin D supplementation on growth parameters of children with vitamin D deficiency: a community based randomized controlled trial

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20174733 ◽

2017 ◽

Vol 4 (6) ◽

pp. 2070

Author(s):

Sagul R. Mugunthan ◽

Yashwant K. Rao ◽

Tanu Midha ◽

Anurag Bajpai

Keyword(s):

Vitamin D ◽

Alkaline Phosphatase ◽

Vitamin D Deficiency ◽

Growth Parameters ◽

Controlled Trial ◽

Vitamin D Supplementation ◽

Community Based ◽

Randomized Controlled ◽

Group 2 ◽

Group 1

Background: Vitamin D deficiency remains the most common cause of rickets globally and is highly prevalent in developing countries including India. This study aimed to compare the efficacy of vitamin D and calcium together with calcium alone on growth parameters of children with vitamin D deficiency in community based setting.Methods: A randomized controlled trial was conducted in community based setting in Kanpur district. Multistage random sampling technique was used to select a total of 395 children between 2 years to 5 years from 5 villages of block Vidhunu. Of these, 138 children were randomized into two groups using balanced block randomization technique. Group 1 received vitamin D with calcium together and group 2 received calcium alone for a period of 12 months. Anthropometry, serum vitamin D, calcium, alkaline phosphatase levels were estimated at baseline and after 12 months. Data was analyzed using SPSS 20. Student’s t test was used to analyze the differences in growth and laboratory parameters in the two groups. Multiple linear regression analysis was used to assess the effect of various factors on the growth parameters.Results: Prevalence of vitamin D deficiency was 78.7%. Baseline characteristics of both groups were similar. After 12 months, group 1 demonstrated significantly greater improvement in weight SD score (21.4%) and height SD score (10.3%) and growth velocity (9.1 cm/year) compared to group 2 (14.3%, 7.8% and 6.9 cm/ year respectively). Also subjects in group 1 showed significantly greater improvement in serum levels of vitamin D, calcium and alkaline phosphatase than group 2.Conclusions: Vitamin D supplementation along with calcium improves the growth of children. Regular supplementation of all children with vitamin D can be considered as a policy for prevention of malnutrition.

Download Full-text

Hypocalcaemia after Total Thyroidectomy

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v25i1.45191 ◽

2020 ◽

Vol 25 (1) ◽

pp. 19-27

Author(s):

Md Zahirul Islam ◽

AF Mohiuddin Khan ◽

Shaikh Nurul Fattah ◽

Dipankar Lodh ◽

Mohammad Nazrul Islam ◽

...

Keyword(s):

Total Thyroidectomy ◽

Serum Calcium ◽

Malignant Disease ◽

Cross Sectional Study ◽

Postoperative Hypocalcemia ◽

Eligibility Criteria ◽

Cross Sectional ◽

Thyroid Pathology ◽

Preoperative Serum ◽

Female Male Female

Objective: To determine whether postoperative hypocalcemia after total thyroidectomy is more frequent in malignant disease than benign disease. Methods: This is a Cross sectional study. The sample size is 126. All the patients were selected according to the eligibility criteria by purposive sampling. Patients were analyzed for age, gender, thyroid pathology, preoperative serum calcium, postoperative serum calcium. Results: Postoperative hypocalcemia was found in 37 (29.37%) patients. Most patients were female (Male: Female= 1: 4.2). Patients having low preoperative serum calcium had developed more postoperative hypocalcemia (p<0.03). Postoperative hypocalcemia was associated with thyroid pathology (p<0.009) and age (p<0.006), not associated with sex (p<0.907). In multivariate analysis very little association between malignant disease and postoperative hypocalcemia was found (p<0.07). Conclusion: The incidence of postoperative hypocalcemia following total thyroidectomy is 29.4% that is higher than the anticipated but is comparable to other published series. For total thyroidectomy surgeons should be aware of postoperative hypocalcemia but prophylactic calcium and vitamin D supplement is not mandatory in all cases. Bangladesh J Otorhinolaryngol; April 2019; 25(1): 19-27

Download Full-text

The relationship between Vitamin D deficiency and polycystic ovary syndrome

African Health Sciences ◽

10.4314/ahs.v20i4.45 ◽

2020 ◽

Vol 20 (4) ◽

pp. 1880-6

Author(s):

Feyzi Gokosmanoglu ◽

Attila Onmez ◽

Hasan Ergenç

Keyword(s):

Vitamin D ◽

Polycystic Ovary Syndrome ◽

Vitamin D Deficiency ◽

Polycystic Ovary ◽

Serum Testosterone ◽

Dehydroepiandrosterone Sulfate ◽

Thyroid Function Tests ◽

Ovary Syndrome ◽

Group 2 ◽

Group 1

Background: Vitamin D deficiency is frequently seen in patients with polycystic ovary syndrome (PCOS) and has been shown to exhibit multiple effects on the disease process. The purpose of this study was to investigate the role of vitamin D deficiency in complex PCOS pathophysiological pathways. Methods: Two hundred sixty-seven patients with PCOS were divided into two groups Group 1 with 25(OH)D3 deficiency, and Group 2 with normal 25(OH)D3. Biochemical and hormonal parameters (androgen hormones, gonadotropins, and thyroid function tests) were compared between the two groups. Results: Eighty-six percent of the patients (n=231) were in Group 1 and 14% (n=36) in Group 2. Statistically signifi- cantly higher concentrations of serum testosterone, dehydroepiandrosterone-sulfate and LH were determined in Group 1 (p<0.05). 25(OH)D3 concentrations were negatively correlated with body mass index (r=−0.459), serum testosterone (r =−0.374) and dehydroepiandrosterone-sulfate levels (r=−0.418); (all; p< 0.05). Conclusion: The study findings show that low 25(OH)D3 levels are associated with high androgen levels in women with PCOS. Vitamin D deficiency should be considered as an additional risk factor in the development of PCOS. We think that providing vitamin D supplementation for women from identified deficiency areas can reduce the risk of PCOS development. Keywords: Polycystic ovarian syndrome; vitamin D deficiency; androgen hormones; testosterone.

Download Full-text

Can YKL-40 be an Inflammatory Biomarker in Vitamin D Deficiency?

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000545 ◽

2019 ◽

Vol 89 (5-6) ◽

pp. 309-313

Author(s):

Ummugulsum Can ◽

Saliha Uysal ◽

Ayse Ruveyda Ugur ◽

Aysun Toker ◽

Uysaler Aslan ◽

...

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Serum Levels ◽

Normal Serum ◽

Plasma Vitamin ◽

Inflammatory Biomarker ◽

Vitamin D Levels ◽

Group 2 ◽

Hs Crp ◽

Group 1

Abstract. Vitamin D deficiency is associated with several non-homeostatic conditions and/or diseases like inflammation, atherosclerosis, cardiovascular disease and mortality. YKL-40 is a glycoprotein, secreted by macrophages, neutrophils and different cell types and it is also associated with inflammation and pathological tissue remodeling. In this study, we aimed to evaluate relationship between the proinflammatory biomarkers YKL-40 and hs-CRP levels and vitamin D deficiency. Our study group includes 45 subjects with vitamin D deficiency (Group 1) (20 M, 25 F; mean age 37.72 ± 7.70 years) and 40 age and sex-matched healthy subjects with normal serum levels of vitamin D (Group 2) (19 M, 21 F; mean age 39.26 ± 7.41 years). Plasma 25 (OH) vitamin D levels were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. Plasma YKL-40 analysis was performed by ELISA. Serum hs-CRP levels were measured by nephelometric method. Plasma vitamin D levels below 20 ng/mL were accepted as vitamin D deficiency. Although we could not find any significant differences by means of serum hs-CRP levels between Group 1 and Group 2 (2.21 (0.27–11.70); 1.79 (0.16–9.85) mg/L, p = 0.247), plasma YKL-40 levels were significantly higher in group 1 than group2 (70.47 (17.84–198.50); 47.14 (4.80–135.48) ng/mL, p = 0.047). In literature, vitamin D deficiency is associated with inflammation. In our study, we found similar hs-CRP levels between groups and higher YKL-40 levels in group 1. Vitamin D deficiency may be related to high YKL-40 levels in terms of causing chronic inflammation.

Download Full-text

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

QJM ◽

10.1093/qjmed/hcab097 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mahmoud Ahmed Mohamed El-Shafaei ◽

Hesham Mohamed Ali Omran ◽

Ehab Mohammed Ali Fadl ◽

Abanoub Magdy Abd El-Malak Ter Elbar

Keyword(s):

Vitamin D ◽

Total Thyroidectomy ◽

Hypovitaminosis D ◽

High Dose ◽

Postoperative Hypocalcemia ◽

Specialized Hospital ◽

Egyptian Patients ◽

Group 2 ◽

Surgery Department ◽

Vitamin D3 Deficiency

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.

Download Full-text

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.

Download Full-text

High prevalence of vitamin D deficiency and reduced bone mass in Parkinson's disease [RETRACTED]

Neurology ◽

10.1212/wnl.49.5.1273 ◽

1997 ◽

Vol 49 (5) ◽

pp. 1273-1278 ◽

Cited By ~ 153

Author(s):

Yoshihiro Sato ◽

Munetsugu Kikuyama ◽

Kotaro Oizumi

Keyword(s):

Parkinson’S Disease ◽

Vitamin D ◽

Parkinson's Disease ◽

Vitamin D Deficiency ◽

Hip Fractures ◽

Mineral Density ◽

Yahr Stage ◽

Z Scores ◽

Group 2 ◽

Group 1

Despite excessive hip fractures in patients with Parkinson's disease (PD), little is known about bone changes in these patients. We measured bone mineral density (BMD; Z scores) in PD patients and analyzed its relation to serum biochemical indices and sunlight exposure. We measured BMD in 71 patients in the second metacarpals and divided the patients into two groups according to functional independence: group 1, Hoehn and Yahr stages 1 and 2; and group 2, stages 3 to 5. In four of 20 patients in group 1 (20%), the Z scores was less than -1.0, indicating osteopenia. In 51 patients in group 2, 31 (61%) had a Z score less than -1.0. The group 1 patients showed a normal mean serum level of 25-hydroxyvitamin D (25-OHD; 21.7 ng/ml), while most group 2 patients were in a deficiency range (group mean 8.9 ng/ml). Many group 2 patients were sunlight deprived. Both groups had elevated serum ionized calcium levels correlating positively with Hoehn and Yahr stage and markedly depressed serum 1,25-dihydroxyvitamin D(1,25-[OH]2D) concentrations, indicating that immobilization-induced hypercalcemia had inhibited 1,25-[OH]2D production. Z scores correlated positively with 25-OHD levels and negatively with parathyroid hormone concentration and Hoehn and Yahr stage. Vitamin D deficiency due to sunlight deprivation and hypercalcemia induces compensatory hyperparathyroidism, which contributes to reduced BMD in PD patients, particularly those who are functionally dependent. Low BMD increases risk of hip fractures in patients with PD but may be improved by vitamin D supplementation.

Download Full-text

The calcium ionophore A23187 is a potent stimulator of the vitamin D3-25 hydroxylase in hepatocytes isolated from normocalcaemic vitamin D-depleted rats

Biochemical Journal ◽

10.1042/bj2550091 ◽

1988 ◽

Vol 255 (1) ◽

pp. 91-97 ◽

Cited By ~ 10

Author(s):

N Benbrahim ◽

C Dubé ◽

S Vallieres ◽

M Gascon-Barré

Keyword(s):

Vitamin D ◽

Enzyme Activity ◽

Serum Calcium ◽

Vitamin D3 ◽

Ionophore A23187 ◽

Potent Stimulator ◽

Group 2 ◽

Group 1

The role played by 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] and/or by calcium on the C-25 hydroxylation of vitamin D3 (D3) was studied in hepatocytes isolated from D-depleted rats which were divided into four treatment groups: Group 1 served as controls, Group 2 received calcium gluconate, Groups 3 and 4 were infused with 1,25(OH)2D3 at 7 and 65 pmol/24 h x 7 days respectively. The treatments normalized serum calcium in all but the controls which remained hypocalcaemic, while serum 1,25(OH)2D3 remained low in Groups 1 and 2 but increased to physiologic and supraphysiologic levels in Groups 3 and 4. The data show that basal D3-25 hydroxylase activities were not significantly affected by any of the treatments. Addition of CaCl2, EGTA, or Quin-2 in vitro revealed that relative to basal values, EGTA strongly inhibited the enzyme activity in all groups (P less than 0.0001), except in G 1; Quin-2 and CaCl2 had no significant effect on the activity of the enzyme in any of the groups. Addition of 1,25(OH)2D3 or A23187 in vitro in the presence of CaCl2 revealed that 1,25(OH)2D3 did not significantly affect enzyme activity, while A23187 was found to stimulate its activity in vitamin D-depleted animals, but most specifically in Group 2 (P less than 0.001); low serum calcium (Group 1) dampened (P less than 0.01), and 1,25(OH)2D3 treatment in vivo totally blunted (P less than 0.001) the response to A23187. The data suggest that 1,25(OH)2D3 supplementation in vivo has per se little or no effect on the basal D3-25 hydroxylase activity. The data show, however, that the magnitude of the response to various challenges in vitro is greatly influenced by the conditioning in vivo of the animals. They also show that A23187 can be a potent stimulator of the enzyme activity, which allowed us to demonstrate a significant reserve for the C-25 hydroxylation of D3 which is well expressed in hepatocytes obtained from D-depleted calcium-supplemented rats.

Download Full-text

Abstract 526: Serum Levels of 25 Hidroxyvitamin D and Its Association With Body Fat, Metabolic Profile, Inflammatory Biomarkers, Blood Pressure and Endothelial Function

Hypertension ◽

10.1161/hyp.62.suppl_1.a526 ◽

2013 ◽

Vol 62 (suppl_1) ◽

Author(s):

Thaís d Ferreira ◽

Márcia R Torres ◽

Débora C Valença ◽

Maria d Rodrigues ◽

José F Neto ◽

...

Keyword(s):

Vitamin D ◽

Endothelial Function ◽

Vitamin D Deficiency ◽

Metabolic Profile ◽

Serum Levels ◽

Inflammatory Biomarkers ◽

Body Adiposity ◽

Group 2 ◽

Deficiency Group ◽

Group 1

Background: Recent evidence suggests that vitamin D deficiency is associated with an increased risk of cardiovascular morbidity and mortality. However, the relationship between vitamin D deficiency and cardiovascular disease risk factors has not been established. Objectives: To investigate the prevalence of vitamin D deficiency and its association with body adiposity, metabolic profile, inflammatory biomarkers, blood pressure (BP) and endothelial function in healthy premenopausal women. Methods: In this cross-sectional study were included 73 adult women who were submitted to the evaluation of: serum levels of 25 hidroxyvitamin D [25(OH)D]; body adiposity; metabolic profile (glucose, insulin, HOMA-IR, leptin, triglycerides and cholesterol); inflammatory biomarkers (adiponectin and C-reactive protein); BP; and endothelial function by serum concentrations of adhesion molecules and by reactive hyperemia index (RHI), determined by peripheral arterial tonometry, using Endo-PAT 2000®. Participants were stratified into 2 groups according to their vitamin D status: with vitamin D deficiency (Group 1; 25 (OH) D < 20ng/ml; n=12), and without vitamin D deficiency (Group 2; 25 (OH) D ≥ 20ng/ml; n=61). Results: The prevalence of vitamin D deficiency was 16% (12 of 73). Women in Group 1 compared with those in Group 2 were older (36.5±3.2 vs. 30.4±1.1 years; p=0.03) and showed higher values of BMI (28.7±1.4 vs. 25.1±0.7kg/m2; p=0.03); % body fat (35.3±1.7 vs. 31.1±0.7%; p=0.02); glucose (88.3±3.2 vs. 80.2±1.1 mg/dl; p=0.01); HOMA-IR (6.3±0.7 vs. 4.4±0.2; p=0.002); and leptin (29.6±3.5 vs. 20.9±1.7 ng/ml; p=0.04). RHI was lower in participants in Group 1 than in Group 2 (1.7±0.1 vs. 2.1±0.1; p=0.02). After adjustments for age and BMI, women with vitamin D deficiency remained with higher levels of glucose and HOMA-IR, and lower levels of RHI. Systolic and diastolic BP were higher in Group 1 than in Group 2 (110.2 ± 5.1 vs. 102.9 ± 1.4mmHg and 72.8 ± 4,0 vs. 68.6 ± 1.3mmHg, respectively), however without statistical significance. The other variables did not differ between groups. Conclusions: In the present study, vitamin D deficiency was associated with higher body adiposity, greater insulin resistance and worse endothelial function in women.

Download Full-text