Preoperative prophylactic active vitamin D to streamline total thyroidectomy

Area of Science:

• Endocrinology
• Surgical Complications
• Pharmacology

Background:

• Hypocalcaemia is a frequent complication following total thyroidectomy (TT).
• Preoperative vitamin D levels are a risk factor, but routine supplementation benefits remain debated.
• This study evaluates the impact of preoperative active vitamin D (alfacalcidol) on hypocalcaemia post-TT.

Purpose of the Study:

• To investigate the efficacy of preoperative alfacalcidol supplementation in preventing hypocalcaemia after TT.
• To assess the impact on hypocalcaemia symptoms and hospital length of stay.
• To determine if routine postoperative calcium monitoring is necessary with this protocol.

Main Methods:

• Retrospective cohort study of 401 patients undergoing TT (Jan 2013-Dec 2020).
• Comparison between patients receiving routine preoperative alfacalcidol (initiated Jan 2017) and those who did not.
• Propensity score matching used to create comparable groups (n=108 each); primary outcome: early postoperative hypocalcaemia (serum calcium < 2.10 mmol/l).

Main Results:

• Preoperative alfacalcidol significantly reduced hypocalcaemia incidence (2 vs 10 cases, P < 0.001).
• Treated patients had higher day 1 serum calcium (2.33 vs 2.27 mmol/l, P = 0.022) and shorter hospital stays (P < 0.001).
• A trend towards fewer hypocalcaemia symptoms was observed in the treated group (18.9% vs 30.5%).

Conclusions:

• Prophylactic preoperative alfacalcidol effectively reduces biochemical hypocalcaemia and hospital stay duration post-TT.
• The findings suggest routine day 1 postoperative serum calcium measurement may not be required.
• Preoperative alfacalcidol is a beneficial strategy for managing patients undergoing total thyroidectomy.