A prospective study on role of supplemental oral calcium and Vitamin D in prevention of postthyroidectomy hypocalcemia

Abstract

Background:Postoperative transient hypocalcemia is sequelae of total thyroidectomy (TT), which is observed in up to 50% of patients. Routine oral calcium and Vitamin D supplementation have been proposed to prevent symptomatic hypocalcemia preventing morbidity and facilitating early discharge.Patients and Methods:A total of 208 patients with nontoxic benign thyroid disorders, undergoing TT, were serially randomized into four groups: Group A (no supplements were given), Group B (oral calcium – 2 g/day given), Group C (calcium and calcitriol – 1 mcg/day are given), and Group D (calcium, calcitriol, and cholecalciferol – 60,000 IU/day are given). Patients were monitored for clinical and biochemical hypocalcemia (serum calcium, [Sr. Ca] <8 mg/dl), along with serum intact parathormone (Sr. PTH) and magnesium 6 h after surgery and Sr. Ca every 24 h. Intravenous (IV) calcium infusion was started, if any of the above four groups exhibit frank hypocalcemia. Patients are followed up with Sr. Ca and Sr. PTH at 3 and 6 months.Results:All groups were age and sex matched. Hypocalcemia was observed in 72/208 (34.61%) cases. Incidence of hypocalcemia was higher in Group A (57.69%) and Group B (50%) compared to Group C (15.38%) and Group D (15.38%). Hypocalcemia necessitating IV calcium occurred in 31/208 (14.90%) patients. IV calcium requirement exceeded in Group A (26.92%) and Group B (23.07%) compared to Group C (5.76%) and Group D (3.84%). There was no statistical difference in basal levels of serum Vitamin D, calcium, magnesium, intact PTH, and 6 h after surgery. Permanent hypoparathyroidism developed in five patients on follow-up.Conclusion:Routine postoperative supplementation of oral calcium and Vitamin D will help in the prevention of postthyroidectomy transient hypocalcemia significantly. Preoperative Vitamin D levels do not predict postoperative hypocalcemia.

Role of oral calcium supplementation alone or with vitamin D in preventing post-thyroidectomy hypocalcaemia

“…After screening and removal of duplicate publications, 15 references were considered to be potentially eligible. After further evaluation, 10 studies [13–16,25,29,30,36–38] finally met our inclusion criteria. Of the 5 excluded studies, 3 were omitted because the treatment groups were routinely administered preoperative VD supplements [6,39] or hydrochlorothiazide.…”

“…Table 1 summarizes the key characteristics of the included studies. Patients in 5 studies [13,16,30,36,38] underwent total thyroidectomy, while those in the remaining studies [14,15,25,29,37] underwent total thyroidectomy and neck dissection. The calcium supplements prescribed in the studies included calcium carbonate, [16,25,30,37] effervescent calcium, [36] calcium, [13,14,29] calcium salts, [38] and Calcimax D3.…”

“…Patients in 5 studies [13,16,30,36,38] underwent total thyroidectomy, while those in the remaining studies [14,15,25,29,37] underwent total thyroidectomy and neck dissection. The calcium supplements prescribed in the studies included calcium carbonate, [16,25,30,37] effervescent calcium, [36] calcium, [13,14,29] calcium salts, [38] and Calcimax D3. [15] The types of VD supplements were Calcitriol, [13,16,25,38] Cholecalciferol, [16,25,30] VD, [14,29] and Calcimax D3.…”

“…The calcium supplements prescribed in the studies included calcium carbonate, [16,25,30,37] effervescent calcium, [36] calcium, [13,14,29] calcium salts, [38] and Calcimax D3. [15] The types of VD supplements were Calcitriol, [13,16,25,38] Cholecalciferol, [16,25,30] VD, [14,29] and Calcimax D3. [15] The most common biochemical cut-off value used to define hypocalcaemia was a total calcium <8.0 mg/dl or ionized calcium <1.0 mmol/L.…”

“…[10] However, serious hypocalcaemic symptoms should be relieved by intravenous calcium supplementation as quickly as possible. [11–16] Moreover, intravenous calcium administration to patients with refractory hypocalcaemia is a major reason for prolonged hospitalization after thyroid surgery. [17]…”