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Post-thyroidectomy hypocalcemia: Is a routine preferable over a selective supplementation?

Luca Sessa1, Carmela De Crea2, Francesca Zotta1

  • 1UOC of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.

American Journal of Surgery
|October 29, 2021
PubMed
Summary

High-dose routine supplementation (HD-RS) effectively prevents symptomatic hypocalcemia after total thyroidectomy (TT). This approach is recommended over PTH-driven selective supplementation (PD-SS) for better patient outcomes.

Keywords:
CalcitriolComplicationsHypocalcemiaHypoparathyroidismOral calciumTotal thyroidectomy

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Area of Science:

  • Endocrinology
  • Surgical Outcomes
  • Metabolic Disorders

Background:

  • Post-thyroidectomy hypocalcemia management lacks comparative studies.
  • Symptomatic hypocalcemia (SH) and readmission are key concerns after total thyroidectomy (TT).

Purpose of the Study:

  • To compare the effectiveness of different post-total thyroidectomy hypocalcemia management protocols.
  • To evaluate PTH-driven selective supplementation (PD-SS) against routine calcium and calcitriol supplementation (preoperative calcitriol administration).

Main Methods:

  • A study involving 300 patients undergoing TT.
  • Patients were divided into three groups: PD-SS, high-dose routine supplementation (HD-RS), and low-dose routine supplementation (LD-RS).

Main Results:

  • HD-RS group had a shorter mean post-operative stay compared to PD-SS and LD-RS groups (p < 0.001).
  • The PD-SS group experienced significantly more SH (p = 0.042).
  • No significant difference in the overall rate of post-operative hypocalcemia was observed among the groups (p = 0.063).
  • No readmissions for SH or hypercalcemia were reported.

Conclusions:

  • High-dose routine supplementation (HD-RS) is the most effective strategy for preventing symptomatic hypocalcemia post-TT.
  • HD-RS does not increase the risk of hypercalcemia-related readmissions.
  • HD-RS is recommended as the preferred management protocol for post-thyroidectomy hypocalcemia.