Routine low-dose calcium supplementation after thyroidectomy does not reduce the rate of symptomatic hypocalcemia: a prospective randomized trial

Abstract

Purpose Routine supplementation of high-dose calcium significantly decreased the risk of postoperative symptomatic hypocalcemia after thyroidectomy. However, there is an ongoing debate about whether the same results can be achieved with low-dose calcium supplementation. Methods Patients (n = 138) who underwent total thyroidectomy for thyroid cancer were 1:1 randomly assigned to receive oral supplements of 1,500 mg/day elemental calcium and 1,000 IU/day cholecalciferol for 2 weeks or no supplementation. Primary objective was to compare the incidence of symptomatic hypocalcemia for 3 days after total thyroidectomy. Secondary objective was to find the predictors for postoperative hypocalcemia in patients with thyroid cancer. Results Sixty-five patients in the calcium group and 69 patients in the control group were finally analyzed. The incidence of symptomatic hypocalcemia showed no difference between the calcium and control group (32.3% vs. 21.7%, P = 0.168). The total dosage of intravenous calcium (593.4 ± 267.1 mg vs. 731.6 ± 622.7 mg, P = 0.430) administered to patients with symptomatic hypocalcemia was also comparable between groups. In a multivariate analysis, parathyroid hormone level of 13 pg/mL at postoperative day 1 was only predictive for symptomatic hypocalcemia, and its incidence was 20.9 times (95% confidence interval, 6.8–64.5) higher in patients with parathyroid hormone <13 pg/mL. Other factors did not predict the development of hypocalcemia, including clinicopathological features and routine supplementation of low-dose calcium. Conclusion Routine low-dose calcium supplementation did not reduce the risk of postoperative hypocalcemia. Patients who may benefit from calcium supplementation should be carefully selected.

The Optimal Parathyroid Hormone Cut-Off Threshold for Early and Safe Management of Hypocalcemia After Total Thyroidectomy

“…1,2,5,18 Univariate analysis of predictors of post-TT hypocalcemia in phase I of the present study showed that iPTH measured immediately after surgery was the only significant predictor (P < .001), while postoperative 24-hour calcium level was not (P ¼ .59), in addition to age, gender, etiology of thyroid disease, neck dissection, or inadvertent parathyroid removal, which is in agreement with others (Table 1). 9,11,16,19,20 However, other studies reported that young age, female gender, ethnicity, central or lateral neck dissection, and parathyroid autotransplantation were significant predictors. 11,15,21e24 Symptomatic hypocalcemia occurred within 24 hours in 58% of patients in phase I of the present study, compared to 56% in the Lee et al 16 study and 76% in the Felho et al 5 study.…”

“…9,11,16,19,20 However, other studies reported that young age, female gender, ethnicity, central or lateral neck dissection, and parathyroid autotransplantation were significant predictors. 11,15,21e24 Symptomatic hypocalcemia occurred within 24 hours in 58% of patients in phase I of the present study, compared to 56% in the Lee et al 16 study and 76% in the Felho et al 5 study. Therefore, relying on the traditional calcium monitoring strategy requires more hospitalization, which can delay discharge of normocalcemic patients or delay treatment in patients who become hypocalcemic.…”

The long-term need for calcium supplementation after incidental parathyroidectomy

“…Conflicting reports exist regarding the correlation between IP and HYP. 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 Many authors suggest that a surgeon must try to find and preserve at least three PGs by any means. Among them, Ponce de Leon-Ballesteros et al.…”

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

“…Las dosis altas de calcio disminuyen la hipocalcemia postquirúrgica, pero se asocian a efectos adversos como nausea, hiporexia, constipación, hipercalcemia y, en este último escenario, disminución en la producción de PTH. Un estudio prospectivo aleatorizado investigó si el suplemento de calcio en baja dosis (calcio 1500 mg/día) más colecalciferol (1 IU/ día) versus no tratamiento previene la hipocalcemia postquirúrgica y encontraron mayor incidencia de hipocalcemia sintomática en el grupo de intervención, aunque la diferencia no fue estadísticamente significativa 23 .…”

“…Finalmente, se puede inferir que no hay protocolos ni estándares que sean aceptados ampliamente para la predicción y prevención de esta complicación, menos aún en contextos de recursos limitados, como el colombiano, por lo que como alternativa se ha optado por administrar profilácticamente calcio/calcitriol como estrategia para prevenir y minimizar la morbilidad secundaria a la hipocalcemia en los pacientes que han sido llevados a tiroidectomía total. Múltiples estudios han demostrado que esta estrategia reduce la incidencia de hipocalcemia bioquímica o sintomática, la estancia hospitalaria, la severidad de los síntomas y el requerimiento de uso de calcio parenteral, sin afectar la recuperación de la función paratiroidea ni la incidencia de hipoparatiroidismo permanente 11,[22][23][24] . Lo que no han aclarado estos estudios es el comportamiento diferencial de distintos esquemas de dosificación de la profilaxis, ni las variables en las cuales se debería basar el clínico para tomar esta decisión.…”