Vitamin D: Implications for Thyroid Surgery

Thyroid and parathyroid surgeries are performed each year on more than 140,000 adults in the United States. Hypocalcemia is one of the most frequent complications of total thyroidectomy—a procedure used for both benign and malignant pathologies of the thyroid gland. In most situations, disruption of calcium homeostasis is felt to be related to disturbance of the parathyroid glands during exploration. Because the parathyroid glands control the amount of calcium in the blood, postoperative supplementation of oral calcium is routine in these cases. When only one side of the neck is explored, the contralateral parathyroid glands are expected to sustain calcium balance; therefore, routine supplementation has not been the standard. The author and colleagues found unexpected symptomatic hypocalcemia in three patients undergoing unilateral neck exploration of the thyroid gland over a 4-month period. This report addresses how the interprofessional team identified the unexpected problem, examined potential causes and contributing factors, and have changed their approach to care for thyroid and parathyroid surgery patients. One of the initial case examples will be described in detail to illustrate the problem.