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Yeim Erbil, MD; Alp Bozbora, MD; Nee Özbey, MD; Halim sever, PhD; Feríhan Aral, MD; Selçuk Özarmaan, MD; Serdar Tezelman, MD

Arch Surg. 2007;142(12):1182-1187.

Hypothesis  Age, postoperative serum parathormone (PTH) level, and preoperative serum 25-hydroxyvitamin D₃ (25-OHD) level predict postoperative hypocalcemia after total thyroidectomy.

Design  Prospective clinical trial.

Setting  Tertiary referral center.

Patients  One hundred thirty patients with nontoxic multinodular goiter. Patients were divided into 2 groups according to the postoperative serum calcium level. Group 1 (n = 32) consisted of patients with a postoperative serum calcium level of 8 mg/dL or less, and group 2 (n = 98) consisted of patients with a postoperative serum calcium level higher than 8 mg/dL.

Interventions  The preoperative serum 25-OHD level and preoperative and postoperative serum calcium and PTH levels were determined.

Main Outcome Measures  The number of patients developing hypocalcemia and prediction of postoperative hypocalcemia by the serum 25-OHD and PTH levels.

Results  Hypocalcemia developed in 32 patients (24.6%) (group 1). The preoperative serum 25-OHD level and postoperative serum calcium and PTH levels in group 1 were significantly lower than in group 2 (P = .001). With logistic regression analysis, factors that were predictive of postoperative hypocalcemia included a preoperative serum 25-OHD level less than 15 ng/mL (P < .001; odds ratio, 558.5), a postoperative serum PTH level less than 10 pg/mL (P = .01; odds ratio, 16.4), and being older than 50 years (P = .01; odds ratio, 4.6).

Conclusions  Age, a low preoperative serum 25-OHD level, and a low postoperative serum PTH level are significantly associated with postoperative hypocalcemia. The low preoperative serum 25-OHD level was more significant than the low postoperative serum PTH level in the prediction of postoperative hypocalcemia.

Author Affiliations: Departments of General Surgery (Drs Erbil, Bozbora, Özarmaan, and Tezelman), Endocrinology (Drs Özbey and Aral), and Public Health (Dr sever), Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

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