Postoperative Tetany in Graves Disease: Important Role of Vitamin D Metabolites

Overview

Journal Ann Surg

Specialty General Surgery

Date 1999 Feb 19

PMID 10024106

Citations 22

Authors

H Yamashita

T Murakami

S Noguchi

M Shiiba

S Watanabe

S Uchino

H Kawamoto

M Toda

N Murakami

Affiliations

Soon will be listed here.

Abstract

Objective: To test the authors' hypothesis of the causal mechanism(s) of postoperative tetany in patients with Graves disease.

Summary Background Data: Previous studies by the authors suggested that postoperative tetany in patients with Graves disease occurs during the period of bone restoration and resulted from continuation of a calcium flux into bone concomitant with transient hypoparathyroidism induced by surgery.

Patients And Methods: A prospective study was carried out to investigate sequential changes in serum levels of intact parathyroid hormone (iPTH), calcium and other electrolytes, 25-hydroxyvitamin D (25OHD), 1,25-dihydroxyvitamin D (1,25(OH)2D), and bone metabolic markers in 109 consecutive patients with Graves disease who underwent subtotal thyroidectomy.

Results: Preoperative serum iPTH levels negatively correlated with ionized calcium levels and positively correlated with 1,25(OH)2D or 1,25(OH)2D/25OHD. After the operation, there was a significant decline in levels of ionized calcium, magnesium, and iPTH. Serum iPTH was not detected in 15 patients after surgery. Four of these 15 patients, and 1 patient whose iPTH level was below normal, developed tetany. Preoperative serum ionized calcium levels were significantly lower, and iPTH levels were higher, in the 5 patients with tetany than in the 11 patients who did not develop tetany despite undetectable iPTH levels. The tetany group had significantly lower serum 25OHD levels and higher 1,25(OH)2D levels, and had increased 1,25(OH)2D/25OHD as an index of the renal 25OHD-1-hydroxylase activity than those in the nontetany group. These results suggest that patients with a high serum level of iPTH as a result of low serum calcium levels (secondary hyperparathyroidism) are susceptible to tetany under conditions of hypoparathyroid function after surgery.

Conclusions: Postoperative tetany occurs in patients with secondary hyperparathyroidism caused by a relative deficiency in calcium and vitamin D because of their increased demand for bone restoration after preoperative medical therapy concomitant with transient hypoparathyroidism after surgery. Calcium and vitamin D supplements may be recommended before and/or after surgery for patients in whom postoperative tetany is expected to develop.

Citing Articles

Significant role of 1,25-dihydroxyvitamin D on serum calcium levels after total thyroidectomy: a prospective cohort study.

Yamashita H, Mori Y, Sato S, Shindo H, Yoshimoto K, Tachibana S Front Endocrinol (Lausanne). 2024; 15:1360464.

PMID: 38803480 PMC: 11128608. DOI: 10.3389/fendo.2024.1360464.

A prospective cross-sectional study on hypocalcemia after total thyroidectomy in patients with Graves' disease: insights on secondary hyperparathyroidism.

Yamashita H, Sato S, Shindo H, Mori Y, Yoshimoto K, Tachibana S Surg Today. 2024; 54(9):1058-1066.

PMID: 38635056 DOI: 10.1007/s00595-024-02848-4.

Effect of Preoperative Vitamin D Deficiency on Hypocalcemia in Patients with Acute Hypoparathyroidism after Thyroidectomy.

Vibhatavata P, Pisarnturakit P, Boonsripitayanon M, Pithuksurachai P, Plengvidhya N, Sirinvaravong S Int J Endocrinol. 2020; 2020:5162496.

PMID: 32774362 PMC: 7396071. DOI: 10.1155/2020/5162496.

Outcomes After Urgent Thyroidectomy Following Rapid Control of Thyrotoxicosis in Graves' Disease are Similar to Those After Elective Surgery in Well-Controlled Disease.

Ali A, Debono M, Balasubramanian S World J Surg. 2019; 43(12):3051-3058.

PMID: 31407090 DOI: 10.1007/s00268-019-05125-5.

Hypocalcemia after Total Thyroidectomy in Graves Disease.

Al Qubaisi M, Haigh P Perm J. 2019; 23.

PMID: 31167702 PMC: 6550310. DOI: 10.7812/TPP/18-188.

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