Routine vs Selective Calcium Supplementation After Total Thyroidectomy: A Randomized Clinical Trial.

Area of Science:

• Endocrinology
• Surgical Complications
• Clinical Trials

Background:

• Postoperative hypocalcemia is a common complication following total thyroidectomy.
• Routine prophylactic calcium and calcitriol (C+C) supplementation is standard but may lead to overtreatment.
• Selective supplementation based on early postoperative parathyroid hormone (PTH) levels is an alternative approach.

Purpose of the Study:

• To compare the incidence of symptomatic and biochemical hypocalcemia between routine prophylactic C+C and selective PTH-guided supplementation.
• To evaluate the effectiveness of selective supplementation in reducing overtreatment after total thyroidectomy.

Main Methods:

• A multicenter, pragmatic, randomized clinical trial involving 258 adult patients undergoing total thyroidectomy.
• Interventions included routine prophylactic C+C for 15 days versus selective supplementation guided by 4-hour postoperative PTH levels (<15 pg/mL).
• Primary outcome was symptomatic hypocalcemia at 15 days; secondary outcomes included biochemical hypocalcemia and adverse events.

Main Results:

• Symptomatic hypocalcemia occurred in 7.8% of the PTH group and 11.1% of the C+C group (OR, 0.68; P=.36).
• Biochemical hypocalcemia was observed in 21.6% of the PTH group and 17.6% of the C+C group (OR, 1.29; P=.53).
• Adverse events were similar; the PTH group required less calcium supplementation.

Conclusions:

• Selective calcium supplementation based on postoperative PTH levels is not superior to routine prophylactic C+C for preventing hypocalcemia after total thyroidectomy.
• Both strategies are effective, and the choice may depend on resource availability and clinical context.
• Further research may explore cost-effectiveness and patient-reported outcomes for each strategy.