Preoperative Vitamin D Cuts Hypocalcemia Risk After Total Thyroidectomy: Study Shows

The analysis, which included data from eight clinical trials, found that vitamin D supplementation, with or without calcium, decreased the risk of hypocalcemia by 23%. Additionally, the incidence of symptomatic hypocalcemia was reduced by 44%, emphasizing the potential of vitamin D to improve postoperative outcomes.

Hypocalcemia, a condition characterized by low calcium levels in the blood, is a common and potentially serious complication after thyroid surgery, particularly total thyroidectomy. It occurs due to inadvertent damage to the parathyroid glands during the procedure, which can lead to impaired calcium regulation. Gian Marco Pace from the Department of Biomedical Sciences at Humanitas University, Pieve Emanuele, Milan, Italy, and colleagues aimed to assess whether preoperative vitamin D supplementation can reduce the incidence of hypocalcemia after total thyroidectomy.

For this purpose, the researchers conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) per the PRISMA statement, focusing on postoperative hypocalcemia and symptomatic hypocalcemia following total thyroidectomy.

The key findings were as follows:

• The search identified 3808 potentially relevant publications, with eight randomized clinical trials (RCTs) included, comprising 902 patients (22.73% male, n = 205/902) with a median age of 48.9 years.
• Four trials administered only vitamin D, three trials administered both calcium and vitamin D and one trial administered vitamin D in the intervention arm and calcium in both arms.
• Pooled results from the eight trials demonstrated a reduced risk of postoperative hypocalcemia in the intervention group (RR, 0.77).
• Excluding studies that administered calcium along with vitamin D still showed a similar reduced risk of postoperative hypocalcemia (RR, 0.74).
• Analysis of six trials on postoperative symptomatic hypocalcemia (n = 564) revealed a reduced risk in the vitamin D group, with or without calcium, compared to the control group (RR, 0.56).

The systematic review and meta-analysis of randomized controlled trials highlights that preoperative vitamin D supplementation, with or without calcium carbonate, significantly reduces the risk of both postoperative hypocalcemia and symptomatic hypocalcemia in patients undergoing total thyroidectomy.

"These findings suggest the potential benefits of incorporating vitamin D supplementation into preoperative care. However, further research is needed to evaluate the cost-effectiveness, standardize dosage and administration, and determine which patients would benefit most from this approach," the authors concluded.

Reference:

Canali, L., Pace, G. M., Russell, M. D., Gaino, F., Malvezzi, L., Mazziotti, G., Lania, A., Spriano, G., Mannstadt, M., Randolph, G. W., & Mercante, G. Preoperative Vitamin D Supplementation to Reduce Hypocalcemia Following Total Thyroidectomy: Systematic Review and Meta-Analysis of Randomized Clinical Trials. Head & Neck. https://doi.org/10.1002/hed.28174