Vitamin D Deficiency Reduces Postthyroidectomy Protracted Hypoparathyroidism Risk. Is Gland Preconditioning Possible?

Lorena Martín-Román; Renan Colombari; María Fernández-Martínez; Iñaki Amunategui-Prats; José Luis Escat-Cortés; Leire Zaraín-Obrador; Enrique Mercader-Cidoncha

doi:10.1210/jendso/bvac174

Vitamin D Deficiency Reduces Postthyroidectomy Protracted Hypoparathyroidism Risk. Is Gland Preconditioning Possible?

J Endocr Soc. 2022 Dec 6;7(1):bvac174. doi: 10.1210/jendso/bvac174. eCollection 2022 Nov 17.

Authors

Lorena Martín-Román¹, Renan Colombari¹, María Fernández-Martínez¹, Iñaki Amunategui-Prats², José Luis Escat-Cortés^{2

3}, Leire Zaraín-Obrador², Enrique Mercader-Cidoncha^{2

3

4}

Affiliations

¹ General Surgery Unit, Department of General and Digestive Surgery, Hospital General Universitario Gregorio Marañón, 28007, Madrid, Spain.
² Endocrine and Metabolic Surgery Unit, Department of General and Digestive Surgery, Hospital General Universitario Gregorio Marañón, 28007, Madrid, Spain.
³ Department of Surgery, School of Medicine, Universidad Complutense de Madrid, 28007, Madrid, Spain.
⁴ Health Research Institute Gregorio Marañón, Immunophysiology Department, Hospital General Universitario Gregorio Marañón, 28007, Madrid, Spain.

Abstract

Context: Hypoparathyroidism is the most frequent complication after total thyroidectomy (PT-hypoPTH). After 1 year, most patients recover parathyroid function; however, the implicated physiologic dynamics remain unknown. Vitamin D deficiency (VDD) is the main cause of secondary hyperparathyroidism. Whether this compensatory hyperparathyroidism could influence parathyroid function recovery (PFR) in the setting of PT-hypoPTH has not been studied.

Objective: This work aimed to evaluate the effect of preoperative VDD on PFR.

Methods: A retrospective study was conducted with a prospectively maintained database including patients undergoing a total thyroidectomy between May 2014 and June 2019. Preoperative vitamin D (25(OH)D) less than 20 mg/mL was defined as VDD. Intact PTH less than 14 pg/mL on postoperative day 1 was defined as PT-hypoPTH. Transient PT-hypoPTH displayed PFR within the first year (early recovery: < 30 days; protracted recovery: > 30 days) whereas definite PT-hypoPTH did not. Survival analysis evaluated the effect of preoperative VDD on PFR, and a binary logistic regression model identified associated factors.

Results: A total of 397 patients were identified. The observed rates of transient, protracted, and definite PT-hypoPTH were 32.9%, 15.1%, and 5.2%, respectively. Rates of VDD were higher in the early-recovery PT-hypoPTH group (55.2% vs 31.5%; P = .01). Preoperative VDD was associated with faster PFR (19 vs 35 days; P = .03) and behaved as a protective factor for protracted PT-hypoPTH (odds ratio 0.47; 95% CI, 0.25-0.881; P = .016) in the multivariable analysis.

Conclusion: Preoperative VDD could act as a preconditioning factor of the parathyroid glands prior to the surgical aggression exerted against them during surgery aiding PFR. Basic research studies and prospective clinical trials are needed to explain the underlying physiological mechanisms and to provide further evidence to improve clinical management.

Keywords: organ preconditioning; postthyroidectomy hypocalcemia; vitamin D deficiency.