Half of endocrinologists do not use vitamin D to prevent post-thyroidectomy hypocalcemia
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In a survey of American Thyroid Association members, nearly half reported using preoperative vitamin D levels to assess risk for hypocalcemia following thyroidectomy.
“Acute hypocalcemia impacts up to 50% of thyroidectomy patients and can be permanent in up to 2% of patients” Jacob P. Noordzij, MD, vice chairman of clinical affairs for otolaryngology and professor of otolaryngology, head and neck surgery at Boston University School of Medicine, and colleagues wrote. “Preoperative vitamin D deficiency may not only lead to postoperative hypocalcemia, but it may also reduce the efficacy of postoperative oral calcium supplements.”
Survey results, published in Clinical Endocrinology, included responses from 225 endocrinologists who are members of ATA. Of those, 94% were fellowship-trained endocrinologists, 60% had been in practice for longer than 10 years, 49% practiced in an academic setting and 34% practiced outside of the United States.
Noordzij and colleagues found that 49% of respondents answered ‘yes’ or ‘sometimes’ when asked whether they test vitamin D levels prior to surgery to assess a patient’s risk for postoperative hypocalcemia. One-third responded that they check vitamin D levels 2 to 8 weeks prior to surgery.
U.S. endocrinologists were 2.5 times more likely to report they assess preoperative vitamin D levels compared with respondents practicing in other countries (95% CI, 1.4-4.54).
Researchers found that 17.5% of respondents did not recommend increasing vitamin D levels for patients with low vitamin D prior to a non-urgent thyroidectomy. Of those who would replete vitamin D levels, 56.4% said they would prescribe supplements for more than 1 month, and those who treat more than 50 cases per year were twice as likely to use a longer regimen.
High-dose vitamin D (50,000 IU per week or more) was more often recommended by respondents in practice for less than 10 years (P < .001), who practiced in the United States (P < .001) and managed fewer than 50 cases per year (P = .02).
Of the cohort, 47.05% of respondents said they would delay thyroidectomy for patients with low vitamin D levels and benign disease, whereas 11.61% of respondents said they would delay surgery for malignant disease.
Respondents in practice for more than 10 years were twice as likely as those with shorter tenure to report prescribing postoperative vitamin D (OR = 1.915; 95% CI, 1.08-3.395. U.S. endocrinologists were 3.48 times more likely than those outside the U.S. to prescribe vitamin D after surgery (95% CI, 1.906-6.355).
“These results can act as a starting point for further studies aimed at considering how demographic and training factors can affect the standard of care for preventing post-thyroidectomy hypocalcemia, especially in regard to the use of vitamin D and calcium supplementation” Noordzij and colleagues wrote.
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