Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Background: Primary hyperparathyroidism (PHPT) is characterized by excessive secretion of parathyroid hormone (PTH), leading to disruptions in calcium metabolism. Preoperative vitamin D deficiency has been hypothesized to influence postoperative PTH levels and is reported to be associated with a slower normalization of PTH levels after
Methods: We conducted a retrospective cohort study analyzing data from TriNetX clinical research platform, representing over 120 million patients in the US collaborative network, to investigate the association between preoperative vitamin D status and postoperative PTH levels among patients diagnosed with primary hyperparathyroidism (PHPT). A total of 10,844 patients with successful Parathyroidectomy (PTX) for PHPTH were included, categorized based on their preoperative vitamin D levels (normal vs. deficient) and postoperative parathyroid hormone (PTH) outcomes (normal vs. high). Chi-square test was used to compare vitamin D deficiency prevalence between groups and significance was defined as p-value <0.05, Odds Ratios (ORs) with 95% confidence intervals (CIs) to assess the strength of association between vitamin D deficiency and postop high PTH. Subgroup analyses were performed based on age, sex, and race.
Results: The mean age of the study cohort was 66±13 years, with a predominance of females (77%). Postoperative PTH levels were high in 20.8% of patients while 79.2% had normal PTH (p <0.0001). Based on vitamin D status, 55.1% of patients had preoperative vitamin D deficiency while 44.9% had normal vitamin D. Among patients with normal vitamin D levels, 40.68% exhibited high postoperative PTH levels compared to 59.32% in patients with vitamin D deficiency (p <0.0001). Vitamin D deficiency was associated with a 24% increase in the odds of having elevated postoperative PTH (OR 1.24, 95% CI 1.1-1.4). Subgroup analysis revealed varying associations across demographics: younger patients (<40 years) with vitamin D deficiency showed significantly higher odds of high PTH (OR 2.1, 95% CI 1.3-3.3). Females exhibited higher odds of high PTH with vitamin D deficiency (OR 1.3, 95% CI 1.2-1.4) compared to males (OR 1.1, 95% CI 0.9-1.3). Ethnicity analysis indicated higher odds among Black patients (OR 1.3, 95% CI 0.96-1.6) and White patients (OR 1.2, 95% CI 1.03-1.3) with vitamin D deficiency.
Conclusion: Our findings suggest a significant association between preoperative vitamin D deficiency and elevated postoperative PTH levels in patients undergoing treatment for PHPT especially patients younger than 40 and Females. Understanding these associations can aid in optimizing preoperative management strategies to potentially improve surgical outcomes in affected individuals.