Seasonal variation in calcium treatment after thyroidectomy as surrogate for post-operative hypocalcemia: a retrospective register-based national cohort study

Thyroid Res. 2022 Mar 19;15(1):5. doi: 10.1186/s13044-022-00123-7.


Background: Hypocalcemia is one of the most common complications of thyroidectomy, and vitamin D deficiency has been found to be an independent risk factor. Sweden is located north of the 55th latitude, resulting in a significant seasonal variation in sun exposure, thereby large variation in the naturally occurring levels of vitamin D. This study aimed to determine if there is a correlation between season of surgery and post-thyroidectomy hypocalcemia.

Methods: We conducted a retrospective register-based observation study on patients who had undergone total thyroidectomy during 2008-2015. In total, 7125 patients operated in Swedish facilities were identified via the Scandinavian Quality Register for Thyroid, Parathyroid, and Adrenal Surgery (SQRTPA). Patients operated during February-April were included in the dark group and patients operated during August-October were included in the bright group. Further stratification was made on the indication for surgery. The primary outcome was post-operative calcium treatment due to hypocalcemia, defined as having received calcium orally or intravenously before discharge.

Results: The risk of receiving post-operative calcium treatment was significantly lower in the bright group (29.7%) compared to the dark group (35.1%), with a relative risk of 0.846 (P < 0.001). This correlation held true if the indication for surgery was goiter or thyrotoxicosis. For malignancy, there was no significant difference between the groups.

Conclusion: In this cohort, total thyroidectomy performed during August-October was associated with a lower rate of calcium treatment given post-operatively when compared to total thyroidectomy performed during February-April. This would indicate a decreased risk of post-operative hypocalcemia if surgery was carried out after the brighter season.

Keywords: Calcium; Hypocalcemia; Seasonal variation; Thyroidectomy; Vitamin D.