Use of pre-operative calcium and vitamin D supplementation to prevent post-operative hypocalcaemia in patients undergoing thyroidectomy: a systematic review

Khatiwada, Aastha; Harris, Andrew

doi:10.1017/s0022215121001523

Cited by 15 publications

(20 citation statements)

References 24 publications

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“…Khatiwada and Harris [ 12 ] performed a systematic review on trials using preoperative calcium and vitamin D supplementation in adults. Three of the nine studies included calcitriol treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Protocols were variable and seven out of nine included trials reported significantly reduced rates of postoperative hypocalcaemia (absolute risk reduction for hypocalcaemia 13–59%, absolute risk reduction for symptomatic hypocalcaemia 11–40%). The authors concluded that preoperative treatment should be considered [ 12 ]. These conflicting results are probably due to the use of variable treatment protocols in variable patient populations, making comparison of studies difficult.…”

Section: Discussionmentioning

confidence: 99%

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The Effect of Pre-Thyroidectomy Calcitriol Prophylaxis on Post-Thyroidectomy Hypocalcaemia in Children

et al. 2022

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Introduction: Transient or permanent hypoparathyroidism is one of the most well-known complications of total thyroidectomy and may lead to symptomatic hypocalcaemia. In children treatment of post-thyroidectomy hypocalcaemia usually consists of postoperative calcium and/or vitamin D supplementation. In 2013 we implemented prophylactic pre-thyroidectomy calcitriol supplementation for all children undergoing total thyroidectomy at the Amsterdam UMC. The objective of this study was to evaluate the efficacy of this prophylactic calcitriol supplementation in preventing post-thyroidectomy hypocalcaemia in children. Methods: In a retrospective case study we included all children (age < 18 years), who underwent a total or completion thyroidectomy in the Amsterdam UMC, between 2000 and 2020. Patients were divided into two groups, patients with preoperative calcitriol supplementation, and those without (controls). Hypocalcaemia was defined as total serum calcium concentration of < 2.0 mmol/l. Primary outcome measure was the occurrence of hypocalcaemia in the first 72 hours after surgery. Secondary outcome measures were occurrence of symptomatic hypocalcaemia and need for medical intervention within the first 72 hours after surgery, and length of hospitalization. Results: A total of 51 patients were included; 26 with calcitriol prophylaxis and 25 controls. There was no significant difference in occurrence of hypocalcaemia (17/26 prophylaxis group; 18/25 control group). Median post-operative calcium concentrations in the first 72 hours were significantly higher in the group with prophylaxis at 30-35 hours (2.26 vs 2.01 mmol/l) and 36-41 hours (2.17 vs 1.92 mmol/l). Occurrence of symptomatic hypocalcaemia, need for medical intervention and length of hospitalization were not significantly different between the groups. Conclusion: Calcitriol prophylaxis resulted in somewhat higher postoperative calcium concentrations, but did not reduce the occurrence of hypocalcaemia or affect clinical outcome measures such as occurrence of symptomatic hypocalcaemia and length of postoperative hospitalization.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Effect of Pre-Thyroidectomy Calcitriol Prophylaxis on Post-Thyroidectomy Hypocalcaemia in Children

et al. 2022

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“…As patients with hypocalcaemia may require longer hospitalization, more biochemical studies, extended pharmacological treatments, and additional medical resources, hypocalcaemia has become a burden for the health care system. Thus, some authors have recommended routine supplementation with calcium or vitamin D. A systematic review indicated that 7 out of the 9 trials included reported statistically significantly reduced rates of postoperative laboratory hypocalcaemia (absolute risk reduction, 13–59%) and symptomatic hypocalcaemia (absolute reduction, 11–40%) following preoperative supplementation [ 19 ]. In several guidelines, for patients with a laboratory confirmed vitamin D deficiency (i.e., 25-OHD < 20 ng/ml), an age- and body weight- dependent therapeutic dosage was recommended to be used for 1–3 months; the dosage should be as follows (with ranges dependent on body weight): for neonates 1,000 IU/day; for infants 2,000–3,000 IU/day; for children and adolescents aged 1–18 years 3,000–5,000 IU/day; for adults and the elderly 7,000–10,000 IU/day or 50,000 IU/week [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Preoperative vitamin D level is significantly associated with hypocalcemia after total thyroidectomy

Chai

Zhang

et al. 2022

BMC Musculoskelet Disord

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Background To evaluate the association of preoperative vitamin D levels with postoperative hypocalcaemia after total thyroidectomy. Methods The medical records of patients who underwent total thyroidectomy between May 2020 and January 2022 and who had a documented preoperative serum 25-hydroxyvitamin D (25-OHD) concentration were retrospectively reviewed. Vitamin D levels were categorized into four groups: <10 ng/mL (severe vitamin D deficiency), 10–20 ng/mL (vitamin D deficiency), 20–30 ng/mL (vitamin D insufficiency), and > 30 ng/mL (vitamin D sufficiency). Multivariate logistic regression was performed to analyse the association of vitamin D levels with the risk of hypocalcaemia after controlling for potential confounding factors. Results A total of 196 patients were included in this study. Of these, 47 (24.0%) had preoperative 25-OHD < 10 ng/mL, 62 (31.6%) had 25-OHD of 10–20 ng/mL, 51 (26.0%) had 25-OHD of 20–30 ng/mL and the remaining 36 (18.4%) had 25-OHD > 30 ng/mL. The incidence of postoperative hypocalcemia was highest in the group of patients with severe vitamin D deficiency (42.6% and 23.4% for postoperative laboratory and symptomatic hypocalcaemia, respectively), followed by the group with vitamin D deficiency (29.0% and 16.1%), the group with vitamin D insufficiency (19.6% and 5.9%) and the group with vitamin D sufficiency (5.6% and 2.8%). Multivariate logistic regression indicated that the odds of postoperative laboratory hypocalcaemia for patients with severe vitamin D deficiency and vitamin D deficiency were 13.20 times (95% CI: 2.69–64.79, P < 0.01) and 6.32 times (95% CI: 1.32–30.28, P = 0.02) greater than for those with vitamin D sufficiency, respectively; while the odds of symptomatic hypocalcaemia for patients with severe vitamin D deficiency was 10.18 times (95% CI: 1.14–90.86, P = 0.04) greater than for those with vitamin D sufficiency. Conclusion Preoperative vitamin D deficiency (< 20 ng/mL), especially severe vitamin D deficiency (< 10 ng/mL), is an independent predictive factor of postoperative hypocalcaemia after total thyroidectomy.

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“…The major criticism is the lack of a clear PTH threshold for both calcium and vitamin D supplementation. Some authors suggest that PTH may not be the only determinant for the development of hypocalcemia and that other factors may play a major role such as vitamin D deficiency [40], dietary habits [41], and other metabolic disorders such as hypomagnesemia [42,43]. Hypomagnesemia is frequently associated with the use of drugs such as aminoglycosides, cyclosporine, cisplatin, amphotericin B, ACE inhibitors, proton pump inhibitors, and some diuretics (thiazides and loop) [44].…”

Section: Discussionmentioning

confidence: 99%

PTH after Thyroidectomy as a Predictor of Post-Operative Hypocalcemia

Metere¹,

Biancucci

Natili³

et al. 2021

Diagnostics

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Post-thyroidectomy hypocalcemia is a frequent complication with significant morbidity, and has been shown to increase hospital stay and readmission rates. The evaluation of serum parathyroid hormone (PTH) levels after thyroidectomy represents a reliable method to predict post-thyroidectomy hypocalcemia, but it remains infrequently used. This retrospective study investigates serum PTH values 3 h after thyroidectomy as a predictor of hypocalcemia. In this study, we enrolled 141 patients aged between 27 and 71 years eligible for total thyroidectomy who presented with multinodular goiter, suspicious nodule on cytological examination, Graves’ disease, or toxic multinodular goiter. Three hours after total thyroidectomy, 53 patients (37.6%) showed a reduction in serum PTH. Of these patients 75.5% developed hypocalcemia by 24 h after surgery and 100% were hypocalcemic after 48 h (p < 0.001). There was no significant difference attributable to the different thyroid diseases, nor to the age of the patients. PTH at 3 h after total thyroidectomy accurately predicts post-operative hypocalcemia. The early detection of patients at risk of developing post-operative hypocalcemia allows for prompt supplementation of calcium and Vitamin D in order to prevent symptoms and allows for a safe and timely discharge.

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Use of pre-operative calcium and vitamin D supplementation to prevent post-operative hypocalcaemia in patients undergoing thyroidectomy: a systematic review

Cited by 15 publications

References 24 publications

The Effect of Pre-Thyroidectomy Calcitriol Prophylaxis on Post-Thyroidectomy Hypocalcaemia in Children

The Effect of Pre-Thyroidectomy Calcitriol Prophylaxis on Post-Thyroidectomy Hypocalcaemia in Children

Preoperative vitamin D level is significantly associated with hypocalcemia after total thyroidectomy

PTH after Thyroidectomy as a Predictor of Post-Operative Hypocalcemia

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