Is routine calcium supplementation necessary in patients undergoing total thyroidectomy plus neck dissection?

Area of Science:

• Endocrinology
• Surgical Oncology
• Nephrology

Background:

• Total thyroidectomy with neck dissection poses a significant risk for postoperative hypocalcemia.
• Identifying predictive factors for symptomatic hypocalcemia is crucial for managing calcium supplementation.

Purpose of the Study:

• To prospectively identify predictors of symptomatic hypocalcemia after total thyroidectomy plus neck dissection.
• To determine the necessity of routine calcium supplementation based on predictive factors.

Main Methods:

• Sixty-five patients undergoing total thyroidectomy plus neck dissection were analyzed.
• Serum calcium (sCa), intact parathyroid hormone (iPTH), serum phosphate (sPhos), and serum magnesium (sMg) levels were monitored.
• Patients were categorized into symptomatic (Group A) and asymptomatic (Group B) hypocalcemic groups.

Main Results:

• Symptomatic hypocalcemia occurred in 18.5% of patients, requiring calcium supplements.
• Significantly lower sCa levels were observed in Group A on postoperative days 1, 2, 3, and 5 (P < 0.05).
• Significantly higher sPhos levels were noted in Group A on postoperative days 2 and 3 (P < 0.05).

Conclusions:

• Symptomatic hypocalcemia typically manifests within 3 days post-surgery.
• A serum calcium level below 1.81 mmol/l accurately predicts symptomatic hypocalcemia.
• Routine calcium supplementation is unnecessary if serum calcium exceeds 1.81 mmol/l.