Calcium and vitamin D reduce hypoparathyroidism and hospital stay after thyroidectomy: A randomized controlled trial

Transient hypoparathyroidism is a common complication after total thyroidectomy, prolonging hospitalization and necessitating calcium and/or vitamin D replacement. Evidence from prospective randomized trials on preventive supplementation remains limited. This study aimed to evaluate whether prophylactic calcium and vitamin D supplementation reduces transient hypoparathyroidism and shortens hospital stay after total thyroidectomy.

In this single-center, prospective, randomized, controlled, open-label trial, 600 patients undergoing total thyroidectomy without central neck dissection were randomized to receive prophylactic oral calcium carbonate/gluconate and alfacalcidol (group A, n = 300) or standard postoperative care (group B, n = 300). Primary outcomes were biochemical and symptomatic hypocalcemia and the need for intravenous calcium. Secondary outcomes included postoperative serum calcium levels and length of hospital stay. Statistical analyses used χ², Student's t test, Mann-Whitney U test, and odds ratio and 95% confidence interval.

Laboratory hypocalcemia (serum calcium <8.5 mg/dL) occurred significantly less often in group A (16.9% vs 39.9%; odds ratio 0.305, 95% confidence interval 0.207-0.451, P < .001). Symptomatic hypocalcemia was also reduced (5.6% vs 12.3%; odds ratio 0.427, 95% confidence interval 0.232-0.785, P < .005), as was the need for intravenous calcium (1.8% vs 9.3%; odds ratio 0.175, 95% confidence interval 0.070-0.441, P < .001). Group A demonstrated higher mean serum calcium levels on postoperative days 1 and 2 (P < .001) and a shorter hospital stay (1.25 days vs 1.7 days, P < .001). Supplementation benefits were consistent across subgroups stratified by malignancy status and preoperative vitamin D levels.

Routine calcium and vitamin D supplementation after total thyroidectomy significantly reduces transient hypoparathyroidism and shortens hospitalization. These findings support its use as a standard postoperative strategy to enhance recovery and reduce health care resource utilization.