Key result
A 4-hour post-operative parathyroid hormone level below 15 pg/mL accurately predicts early postoperative hypocalcemia with 100% specificity, while vitamin D deficiency showed no significant link.
Why the study?
Preoperative vitamin D deficiency is a potential risk factor for post-thyroidectomy hypocalcemia, but literature inconsistencies exist, potentially due to methodological differences.
Do postoperative 4-hour PTH and preoperative Vitamin D levels predict postoperative hypocalcemia in patients undergoing total or near-total thyroidectomy?
Observational (n=70)
No
Do postoperative 4-hour PTH and preoperative Vitamin D levels predict postoperative hypocalcemia in patients undergoing total or near-total thyroidectomy?
Effect estimate: AUROC 0.707 (95% CI 0.589-0.826)
p-value: p=<0.001
Postoperative 4-hour PTH is a strong predictor of early postoperative hypocalcemia after thyroidectomy, while preoperative Vitamin D levels do not significantly predict this complication.
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Supports 4-hour PTH-guided hypocalcemia management after thyroidectomy; confirms its value while challenging vitamin D as predictor.
Background: Post-thyroidectomy hypocalcemia is the most frequent complication after total thyroidectomy. Preoperative vitamin D deficiency has been suggested as a potential risk factor, but inconsistencies exist in the literature, possibly related to methodological differences. To evaluate whether study design and risk of bias influence the association between preoperative vitamin D deficiency and postoperative hypocalcemia in patients undergoing total thyroidectomy.Methods: This is a secondary analysis of a previously conducted systematic review. We included observational studies evaluating the association between preoperative vitamin D levels and postoperative hypocalcemia. Methodological quality was assessed using the QUIPS tool. Subgroup analyses were performed based on study design (prospective vs. retrospective) and overall risk of bias (high vs. low/moderate). Results: Twenty-eight studies comprising 4994 patients were included. Nineteen studies had a prospective design. Both prospective and retrospective studies showed an association between vitamin D deficiency and hypocalcemia; however, the effect size was lower in prospective studies (OR 1.95; 95% CI 1.28-2.97) compared to retrospective ones (OR 2.18; 95% CI 1.02-4.7). Studies with high risk of bias showed a significant association (OR 2.55; 95% CI 1.4-3.6), while those with low/moderate risk did not (OR 1.71; 95% CI 0.96-3.06). Conclusion: Study design and methodological quality influence the reported association between vitamin D deficiency and postoperative hypocalcemia. These findings suggest caution when recommending preoperative vitamin D supplementation based solely on observational data.
Lopera et al. (2026) conducted an observational in Total or near-total thyroidectomy (n=70). 4-hour post-operative PTH and preoperative Vitamin D measurement was evaluated on Biochemical hypocalcemia (AUROC 0.707, 95% CI 0.589-0.826, p=<0.001). A 4-hour post-operative parathyroid hormone level below 15 pg/mL accurately predicts early postoperative hypocalcemia with 100% specificity, while vitamin D deficiency showed no significant link.
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