Use of prophylactic oral calcium after total thyroidectomy: a prospective study

Abstract

Objective: The aim of this study was to evaluate the use of prophylactic oral calcium after total thyroidectomy in the prevention of symptomatic hypocalcemia, and to develop a rational strategy of oral calcium supplementation following this type of surgery. Subjects and methods: Prospective study including 47 patients undergoing total thyroidectomy from January 2007 to February 2012. The patients were allocated to one of the following groups: I (no postoperative calcium) or II (oral calcium 3 g per day). Oral calcium was started at the first postoperative day and administered until the sixth postoperative day. The patients were followed up for a minimum of 6 months and evaluated with a minimum of five measurements of ionized calcium: preoperative, 16 hours after surgery, seventh postoperative day, and at postoperative days 90 (PO90) and 180 (PO180). The cohort included three men and 44 women, of whom 24 (51.9%) had benign thyroid disease, and 23 had suspected or confirmed malignant disease. Results: When compared with Group II, Group I had significantly higher rates of postoperative biochemical hypocalcemia at PO1 and PO180, and of symptomatic hypocalcemia at PO1, PO7, and PO90. Other data were not significantly different between the groups. Conclusion: We conclude that postoperative calcium supplementation effectively prevents symptomatic and biochemical hypocalcemia after total thyroidectomy, and can be safely used after this procedure. The presented strategy of oral calcium supplementation may be implemented in a viable manner. Arch Endocrinol Metab. 2017;61(5):447-54

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.…”

“…Sun et al defined laboratory hypocalcaemia as serum calcium <2.1 mmol/L [37] while Langner et al defined biochemical hypocalcaemia as ionized calcium <1.1 mmol/L. [36] The most common indication for intravenous supplementation was the persistence of hypocalcaemic symptoms despite oral supplementation. Choe et al reported that intravenous supplementation was needed only when patients had severe or worsening hypocalcaemic symptoms combined with Ca < 7.5 mg/dl or ionized calcium <0.8 mmol/L.…”

Post-thyroidectomy Hypocalcemia - Risk Factors and Management

“…Moreover, a combination of PTH and calcium assay might be more accurate to indicate the need for calcium replacement, for instance a value of intact PTH one hour postoperatory of higher than 10 pg/mL and a total calcium level higher than 8.5 mg/dL makes calcium supplementation unnecessary (28). Alternatively, a combination of PTH 6 hours after thyroidecomy of less than 12.1 pg/mL and serum total calcium during the first postoperatory day of less than 7.97 mg/dL (a sensitivity of 93.9% and a specificity of 100%) offers a total sensitivity and a specificity of 100% to predict hypocalcemia thus indicating the need of oral intervention as preventive replacement (29).…”