Comparison Between Perioperative Treatment with Calcium and with Calcium and Vitamin D in Prevention of Post Thyroidectomy Hypocalcemia

Abstract

Even though thyroid surgery is quite safe, mechanical damage, devascularization or inadvertent removal of the parathyroid glands are possible. Though postoperative mortality is extremely low, post thyroidectomy hypocalcemia is one of the most common and potentially life-threatening complication following thyroid surgery. The clinical manifestation varies from minimal twitching to life threatening tetany and can prolong the hospital stay. The purpose of this study is to evaluate the clinical usefulness of routine oral calcium with Vitamin D supplements in reducing the incidence and severity of hypocalcemia after total thyroidectomy. This safe and cost effective therapy may prevent the threatening complications like tetany and reduce the hospital stay.

Meta-analysis of routine calcium/vitamin D3 supplementationversusserum calcium level-based strategy to prevent postoperative hypocalcaemia after thyroidectomy

“…). The reasons for exclusion of studies were a non‐randomized design, different intervention, and a preoperative intervention with no data on postoperative hypocalcaemia. Study characteristics are summarized in Table and Table S2 (supporting information).…”

Post-thyroidectomy hypocalcemia and related complications

“…According to several studies conducted by different authors, variation in urinary calcium concentration was not different when comparing thyroidectomized patients with those undergoing other procedures (Edafe, Mech, & Balasubramanian, 2019;Mazoni et al, 2022;Nemade, Rokade, Pathak, Tiwari, & Sonkhedkar, 2014;Ponce de León-Ballesteros et al, 2020). The authors found that calciuria decreased after all procedures, returning to preoperative values on the second day after surgery.…”

Hipocalcemia posterior a tiroidectomía total: Análisis de dosis para suplemento rutinario profiláctico

“…Otra variable utilizada para predecir y estratificar el riesgo de hipocalcemia es la medición seriada de niveles de calcio sérico. El nadir de hipocalcemia es a las 24-72 horas después de cirugía, aunque puede ocurrir hasta 15 días después, y se ve alterado por esquemas profilácticos de calcio/ calcitriol, estado acido-base, estado nutricional, niveles de magnesio, albumina y citrato, hemodilución, deficiencia de vitamina D prequirúrgica, liberación de calcitonina por manipulación tiroidea o síndrome de hueso hambriento 1,5,11,[18][19][20][21] . De esta manera, se considera que la variación del calcio sérico en las primeras horas de cirugía predice la evolución posterior de la siguiente forma: la presencia de una tendencia neutral o positiva predice normocalcemia con valor predictivo positivo del 86-100 % y la tendencia negativa se asocia con desarrollo posterior de hipocalcemia 18 .…”