Impact of preoperative Vitamin D3 administration on postoperative hypocalcaemia in patients undergoing total thyroidectomy (HypoCalViD): study protocol for a randomized controlled trial

Abstract

BackgroundTotal thyroidectomy is increasingly used as a surgical approach for many thyroid conditions. Subsequently, postoperative hypocalcaemia is observed with increasing frequency, often resulting in prolonged hospital stay, increased use of resources, reduced quality of life and delayed return to work. The administration of vitamin D is essential in the therapy of postoperative hypocalcaemia; calcitriol is most commonly used. What has not been examined so far is whether and how routine preoperative vitamin D prophylaxis using calcitriol can help to prevent postoperative hypocalcaemia. This study evaluates routine preoperative calcitriol prophylaxis for all patients who are to undergo a total thyroidectomy, compared with the current standard of post-treatment, i.e., selective vitamin D treatment for patients with postoperative hypocalcaemia.Methods/designThis clinical observational (minimal interventional clinical trial) trial is a multicentre, prospective, randomized superiority trial with an adaptive design. Datasets will be pseudonymized for analysis. Patients will be randomly allocated (1:1) to the intervention and the control groups. The only intervention is 0.5 μg calcitriol orally twice a day for 3 days prior to surgery. For the primary endpoint measure (number of patients with hypocalcaemia), hypocalcaemia is defined as serum calcium of less than 2.1 mmol/l on any day during the postoperative course; this measure will be analyzed using a Chi-square test comparing the two groups. Secondary endpoint measures, such as number of days to discharge, quality of life, and economic parameters will also be analyzed.DiscussionBy virtue of the direct comparison of clinically and economically relevant endpoints, the efficacy as well as efficiency of preoperative calcitriol prophylaxis of hypocalcaemia will be clarified. These results should be available 24 months after the first patient has been enrolled. The results will be used to inform a revised practice parameter guideline of whether or not to recommend preoperative calcitriol for all patients in whom total thyroidectomy is planned.Trial registrationDeutsches Register Klinischer Studien, DRKS00005615 (Feb.12.2016).

23-hour observation endocrine neck surgery: lessons learned from a case series of over 1700 patients

“…Concerning the Grave's disease, we usually consider this a minor risk factor and we usually schedule these patients for short stay surgery (44). Concerning the hypocalcemia, some experiences reported a protective effect of a preoperative administering of vitamin D (45), that is a common practice at our institution. Moreover, we systematically exclude from the short stay surgery the cancers that need a neck dissection (46)(47).…”

Role of vitamin D as a risk factor in post-thyroidectomy transient hypocalcemia: a prospective study

“…The advantage of using vitamin D as a predictor for postoperative hypocalcaemia is (i) easy to estimate (ii) any deficiency can be easily corrected. 1,4,5 However, the association between low vitamin D and post-operative hypocalcaemia has not been demonstrated regularly.6-8 …”