J Endocrinol Metab

Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc

Journal website http://www.jofem.org

Original Article

Volume 7, Number 6, December 2017, pages 172-177

The Impact of Vitamin D Status on Preoperative Ultrasound Findings and Parathyroidectomy Outcomes in Patients With Primary Hyperparathyroidism

Figure 1. (a) Regression analysis with vitamin D as dependent variable with weight of parathyroid gland in patients with single gland disease. (b) Regression analysis with vitamin D as dependent variable with combined weight of parathyroid glands in patients with multiple gland disease.

**Table 1.** Patient Demographics and Biochemical Parameters Before and After Parathyroidectomy
Variable	Pre-operative	Post-operative	P value
All data expressed as mean ± standard deviation.
Age (years)	64.2 ± 11.7	-
Sex (M/F)	16/65	-
Duration of stay (days)	4.3 ± 2.9	-
Parathormone (pmol/L)	15.2 ± 10.9	5.6 ± 2.4	< 0.00001
Calcium (mmol/L)	2.8 ± 0.2	2.3 ± 0.2	< 0.00001
Adjusted calcium (mmol/L)	2.9 ± 0.2	2.4 ± 0.1	< 0.00001
Phosphate (mmol/L)	0.8 ± 0.2	1.1 ± 0.2	< 0.00001
Alkaline phosphatase (U/L)	105.9 ± 42.8	88.3 ± 29.5	< 0.00001
Creatinine (µmol/L)	74.2 ± 21.9	76.6 ± 24.3	0.01
eGFR (mL/min/1.73 m²)	75.4 ± 13.4	76.2 ± 14.6	0.24
TSH (mU/L)	1.8 ± 1.1	-
FT4 (pmol/L)	15.3 ± 2.6	-
Vitamin D (nmol/L)	36.9 ± 19.7	-

Table 1. Patient Demographics and Biochemical Parameters Before and After Parathyroidectomy

Variable

Pre-operative

Post-operative

P value

All data expressed as mean ± standard deviation.

Age (years)

64.2 ± 11.7

Sex (M/F)

16/65

Duration of stay (days)

4.3 ± 2.9

Parathormone (pmol/L)

15.2 ± 10.9

5.6 ± 2.4

< 0.00001

Calcium (mmol/L)

2.8 ± 0.2

2.3 ± 0.2

< 0.00001

Adjusted calcium (mmol/L)

2.9 ± 0.2

2.4 ± 0.1

< 0.00001

Phosphate (mmol/L)

0.8 ± 0.2

1.1 ± 0.2

< 0.00001

Alkaline phosphatase (U/L)

105.9 ± 42.8

88.3 ± 29.5

< 0.00001

Creatinine (µmol/L)

74.2 ± 21.9

76.6 ± 24.3

0.01

eGFR (mL/min/1.73 m²)

75.4 ± 13.4

76.2 ± 14.6

0.24

TSH (mU/L)

1.8 ± 1.1

FT4 (pmol/L)

15.3 ± 2.6

Vitamin D (nmol/L)

36.9 ± 19.7

**Table 2.** Characteristics of Gland Involvement by Ultrasonography as per Vitamin D Status
Vitamin D status (nmol/L)	< 30 (deficient), n = 36	≥ 30 and < 50 (insufficient), n = 27	≥ 50 (sufficient), n = 18
Single gland disease (SGD)
Right superior gland	1 (2.8%)	1 (3.7%)	1 (5.5%)
Left superior gland	0 (0.0%)	2 (7.4%)	0 (0.0%)
Right inferior gland	7 (19.4%)	4 (14.8%)	8 (44.5%)
Left inferior gland	12 (33.4%)	8 (29.6%)	1 (5.5%)
No gland involvement	16 (44.4%)	12 (44.5%)	8 (44.5%)
Multiple gland disease (MGD)	0	0	0

Table 2. Characteristics of Gland Involvement by Ultrasonography as per Vitamin D Status

Vitamin D status (nmol/L)

< 30 (deficient), n = 36

≥ 30 and < 50 (insufficient), n = 27

≥ 50 (sufficient), n = 18

Single gland disease (SGD)

Right superior gland

1 (2.8%)

1 (3.7%)

1 (5.5%)

Left superior gland

0 (0.0%)

2 (7.4%)

0 (0.0%)

Right inferior gland

7 (19.4%)

4 (14.8%)

8 (44.5%)

Left inferior gland

12 (33.4%)

8 (29.6%)

1 (5.5%)

No gland involvement

16 (44.4%)

12 (44.5%)

8 (44.5%)

Multiple gland disease (MGD)

**Table 3.** Relationship Between Ultrasound Findings and Histology as per Vitamin D Status
Diagnosis test	Histology	Sensitivity	Specificity	PPV	NPV
All value in brackets are expressed as percentages.
All patients	USS	Positive	45 (55.5)	0 (0)	58.4%	100%	100%	11.1%
		Negative	32 (39.5)	4 (5.0)
Vitamin D
Deficient	USS	Positive	20 (55.5)	0 (0)	57.1%	100%	100%	6.2%
		Negative	15 (41.7)	1 (2.8)
Insufficient	USS	Positive	15 (55.5)	0 (0)	62.5%	100%	100%	25.0%
		Negative	9 (33.3)	3 (11.2)
Sufficient	USS	Positive	10 (55.5)	0 (0)	55.8%	100%	100%	12.5%
		Negative	7 (38.9)	1 (5.6)

Table 3. Relationship Between Ultrasound Findings and Histology as per Vitamin D Status

Diagnosis test

Histology

Sensitivity

Specificity

PPV

NPV

Positive

Negative

All value in brackets are expressed as percentages.

All patients

USS

Positive

45 (55.5)

0 (0)

58.4%

100%

11.1%

Negative

32 (39.5)

4 (5.0)

Vitamin D

Deficient

USS

Positive

20 (55.5)

0 (0)

57.1%

100%

6.2%

Negative

15 (41.7)

1 (2.8)

Insufficient

USS

Positive

15 (55.5)

0 (0)

62.5%

100%

25.0%

Negative

9 (33.3)

3 (11.2)

Sufficient

USS

Positive

10 (55.5)

0 (0)

55.8%

100%

12.5%

Negative

7 (38.9)

1 (5.6)

**Table 4.** Post Parathyroidectomy Findings According to Vitamin D Status
Vitamin D status (nmol/L)	< 30 (deficient), n = 36	≥ 30 and < 50 (insufficient), n = 27	≥ 50 (sufficient), n = 18	P value
Single gland removed	21	18	16
Weight of gland (g)	1.42 ± 1.35	1.11 ± 1.39	0.58 ± 0.48	0.10
Histology
Benign adenoma	15 (71.4%)	14 (77.8%)	14 (87.5%)
Chief cell adenoma	6 (28.6%)	1 (5.5%)	0 (0%)
Others (normal, hyperplasia)	0 (0%)	3 (16.7%)	2 (12.5%)
Multiple gland removed	15	9	2
Combined weight of glands (g)	1.81 ± 2.79	0.93 ± 0.58	0.59 ± 0.33	0.55
Mean number of gland excised	2.46 ± 1.00	2.55 ± 1.00	3.50 ± 0.70	0.28
Histology
Benign adenoma	14 (93.3%)	6 (66.7%)	2 (100%)
Chief cell adenoma	0 (0%)	0 (0%)	0 (0%)
Others (normal, hyperplasia)	1 (6.7%)	3 (33.3%)	0 (0%)

Table 4. Post Parathyroidectomy Findings According to Vitamin D Status

Vitamin D status (nmol/L)

< 30 (deficient), n = 36

≥ 30 and < 50 (insufficient), n = 27

≥ 50 (sufficient), n = 18

P value

Single gland removed

Weight of gland (g)

1.42 ± 1.35

1.11 ± 1.39

0.58 ± 0.48

0.10

Histology

Benign adenoma

15 (71.4%)

14 (77.8%)

14 (87.5%)

Chief cell adenoma

6 (28.6%)

1 (5.5%)

0 (0%)

Others (normal, hyperplasia)

0 (0%)

3 (16.7%)

2 (12.5%)

Multiple gland removed

Combined weight of glands (g)

1.81 ± 2.79

0.93 ± 0.58

0.59 ± 0.33

0.55

Mean number of gland excised

2.46 ± 1.00

2.55 ± 1.00

3.50 ± 0.70

0.28

Histology

Benign adenoma

14 (93.3%)

6 (66.7%)

2 (100%)

Chief cell adenoma

0 (0%)

Others (normal, hyperplasia)

1 (6.7%)

3 (33.3%)

0 (0%)