Calcium Management after Thyroidectomy: A Simple and Cost‐Effective Method

Singer, Michael C.; Bhakta, Dimpal; Terris, David J.; Seybt, Melanie W.

doi:10.1177/0194599811416318a65

Cited by 24 publications

(35 citation statements)

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“…An all-inclusive prophylactic approach to preventing postoperative hypocalcemia is to routinely initiate treatment with oral calcium with or without calcitriol (41,42). This can be the most cost-effective approach because of the low cost of oral calcium preparations.…”

Section: Postoperative Prophylaxismentioning

confidence: 99%

American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: Postoperative Hypoparathyroidism - Definitions and Management

Bimston²,

et al. 2015

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Section: Postoperative Prophylaxismentioning

confidence: 99%

American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: Postoperative Hypoparathyroidism - Definitions and Management

Bimston²,

et al. 2015

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“…Routine calcium supplementation would save $29,365 per quality-adjusted life year (QALY), with a savings of $62 per patient and an incremental benefit of 0.002 QALYs [36]. Singer et al reported that the cost of a 3-week regimen of calcium carbonate is approximately $15, which is less expensive than either the cost of overnight admission or published laboratory protocols that are designed to predict the risk of hypocalcemia [37].…”

Section: Discussionmentioning

confidence: 99%

Role of Postoperative Vitamin D and/or Calcium Routine Supplementation in Preventing Hypocalcemia After Thyroidectomy: A Systematic Review and Meta-Analysis

2013

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Background. Transient hypocalcemia is a frequent complication after total thyroidectomy. Routine postoperative administration of vitamin D and calcium can reduce the incidence of symptomatic postoperative hypocalcemia. We performed a systematic review to assess the effectiveness of this intervention. The primary aim was to evaluate the efficacy of routine postoperative oral calcium and vitamin D supplementation in preventing symptomatic post-thyroidectomy hypocalcemia. The second aim was to draw clear guidelines regarding prophylactic calcium and/or vitamin D therapy for patients after thyroidectomy. Methods. We identified randomized controlled trials comparing the administration of vitamin D or its metabolites to calcium or no treatment in adult patients after thyroidectomy. The search was performed in PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Google Scholar, and Web of Knowledge databases. Patients with a history of previous neck surgery, calcium supplementation, or renal impairment were excluded.Results. Nine studies with 2,285 patients were included: 22 in the vitamin D group, 580 in the calcium group, 792 in the vitamin D and calcium group, and 891 in the no intervention group, with symptomatic hypocalcemia incidences of 4.6%, 14%, 14%, and 20.5%, respectively. Subcomparisons demonstrated that the incidences of postoperative hypocalcemia were 10.1% versus 18.8% for calcium versus no intervention and 6.8% versus 25.9% for vitamin D and calcium versus no intervention. The studies showed a significant range of variability in patients' characteristics. Conclusions. A significant decrease in postoperative hypocalcemia was identified in patients who received routine supplementation of oral calcium or vitamin D. The incidence decreased even more with the combined administration of both supplements. Based on this analysis, we recommend oral calcium for all patients following thyroidectomy, with the addition of vitamin D for high-risk individuals. The Oncologist 2013;18:533-542 Implications for Practice: Excision of the thyroid gland (thyroidectomy) is a common therapy for thyroid diseases. It is a safe procedure if performed by an expert surgeon. Temporary low serum calcium level (transient hypocalcaemia) is the most common complication of this surgery. This complication may occur in 10%-45% of the cases and may result in mild to severe symptoms. Postoperative treatment with calcium and vitamin D may prevent or minimize hypocalcemic symptoms; however, until now, clear guidelines for the optimal use of these supplements were not available. The aim of this review is to compare the outcomes of different supplementation protocols in an attempt to assist surgeons decrease the incidence of hypocalcemia after thyroid surgery. INTRODUCTIONThyroid surgery is one of the most frequently performed surgical procedures worldwide [1]. In fact, total thyroidectomy is now widelyacceptedasthegoldstandardforthemanagementofthyroid carcinoma and benign bilateral thyroid disease due to s...

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“…A 2012 study from the US demonstrated that calcium supplementation is considerably less expensive than either the cost of overnight admission or adhering to published laboratory protocols designed to predict risk of hypocalcaemia, and that it is a safe and cost effective method of preventing hypocalcaemia. 19 Several large studies have demonstrated that thyroidectomy can be carried out both safely and effectively as a day procedure. Seybt and Terris had 208 same-day discharges (49.8%) and 210 patients (50.2%) admitted for a mean of 1.8 days.…”

Section: 18mentioning

confidence: 99%

Thyroid surgery as a 23-hour stay procedure

Perera

Patel

2014

annals

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INTRODUCTIONThe main barriers to short stay thyroidectomy are haemorrhage, bilateral recurrent laryngeal nerve palsy causing respiratory compromise and hypocalcaemia. This study assessed the safety and effectiveness of thyroidectomy as a 23-hour stay procedure. METHODS All patients undergoing total or completion thyroidectomy were prescribed calcium and vitamin D 3 supplements following surgery. Retrospective analysis identified patients admitted for longer than 23 hours and any readmissions. RESULTS A total of 164 patients were admitted for 23-hour stay thyroid surgery over a 25-month period between 2008 and 2010. Four patients (2%) required admission for longer than 23 hours. No patients required emergency intervention for postoperative haemorrhage or airway compromise. Biochemical hypocalcaemia (despite calcium supplements) was detected in one patient when measured at the outpatient clinic two weeks following surgery. Twelve patients (7.3%) attended the accident and emergency department following discharge; four required admission for intravenous antibiotics for wound infection and one for biochemical hypocalcaemia. CONCLUSIONS This single centre UK experience demonstrates that thyroidectomy can be carried out both safely and effectively as a 23-hour stay procedure. Prophylactic prescription of calcium and vitamin D 3 reduces hypocalcaemia, and thereby also prolonged admission and readmission due to hypocalcaemia. Supplements are an acceptable, cost effective method of reducing hypocalcaemia and shortening postoperative length of stay.

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Calcium Management after Thyroidectomy: A Simple and Cost‐Effective Method

Abstract: Objective: Hypocalcemia is one of the principal complications of total or completion thyroidectomy. A number of different protocols for managing this potential complication have been published. Our simple postoperative regimen is described and the safety and cost-effectiveness assessed.

Cited by 24 publications

References 0 publications

American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: Postoperative Hypoparathyroidism - Definitions and Management

American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: Postoperative Hypoparathyroidism - Definitions and Management

Role of Postoperative Vitamin D and/or Calcium Routine Supplementation in Preventing Hypocalcemia After Thyroidectomy: A Systematic Review and Meta-Analysis

Thyroid surgery as a 23-hour stay procedure

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