The Role of Perioperative Vitamin D Measurement after Total Thyroidectomy as a Predictor of Hypocalcemia

Background: Temporary hypocalcemia, a common occurrence after total thyroidectomy, affects up to 35% of patients, presenting mild to severe symptoms such as paresthesia, tingling, cramps, tetany, and convulsion.Aim: To discuss the relation between vitamin D and postoperative hypocalcemia in patients undergoing total thyroidectomy and to determine the optimal vitamin D threshold level to reduce hypocalcemia risk, enabling judicious and goal-directed vitamin D replacement.Patients and methods: This prospective study was conducted on 200 patients with hypocalcaemia underwent total thyroidectomy in kasr el-ainy university hospitals, Faculty of Medicine, Cairo University from 2023Results: Age, female patients, ALP, and hospital stay were significantly higher in patients who developed postoperative Ca ≤ 8 mg/dl than those who developed postoperative Ca > 8 mg/dl (P value <0.001). Preoperative and postoperative Ca and preoperative 25-OHD were significantly lower in patients who developed postoperative Ca ≤ 8 mg/dl than those who developed postoperative Ca > 8 mg/dl (P value <0.001). Albumin and creatinine were insignificantly different between patients who developed postoperative Ca ≤ 8 mg/dl and those who developed postoperative Ca > 8 mg/dl. Conclusion: Patients who developed postoperative hypocalcemia had significantly lower preoperative 25-OHD levels compared to those who did not develop hypocalcemia. Additionally, older age and female gender were identified as risk factors for postoperative hypocalcemia. The study also demonstrated a positive correlation between postoperative calcium levels and preoperative 25-OHD levels, suggesting that adequate vitamin D status may play a protective role against postoperative hypocalcemia.