Effectiveness of Immediate Oral Calcium Supplementation After Thyroidectomy on Early Postoperative Hypocalcemia: A...

Hypocalcemia is the most frequent complication following total thyroidectomy (TT), associated with neuromuscular symptoms and prolonged hospitalization. Although prophylactic oral calcium supplementation is commonly used to prevent postoperative hypocalcemia, its routine use remains debated.

This study aimed to assess the effectiveness of immediate postoperative oral calcium supplementation in reducing the incidence of hypocalcemia following thyroidectomy.

This single-center retrospective cohort study included patients who underwent TT or partial thyroidectomy (PT) between January 2018 and December 2022. Patients were categorized into two groups: those who received immediate postoperative oral calcium prophylaxis (most commonly calcium carbonate 500-1000 mg daily, with or without vitamin D, based on surgeon preference) and those who received standard care without prophylaxis. The primary outcome was hypocalcemia within 48 hours, defined as total serum calcium <8.5 mg/dL and/or the presence of clinical symptoms. Categorical variables were compared using the chi-square test, and statistical significance was set at p < 0.05.

Seventy-four patients were initially screened; 72 patients (mean age: 44.9 ± 12 years; 82.4% female) were included in the final analysis after excluding two with missing postoperative data. Among them, 21 received calcium prophylaxis and 51 received standard care. Hypocalcemia occurred in 0% of patients in the prophylaxis group compared to 35.3% in the control group (p = 0.002). Stratified analysis of the high-risk TT group (n=52) showed a significant reduction in hypocalcemia from 54.5% (18/33) in the control group to 0% (0/19) in the prophylaxis group (p < 0.001). No adverse events related to calcium supplementation were observed.

Immediate postoperative oral calcium supplementation significantly reduces early postoperative hypocalcemia after thyroidectomy. Given its safety, low cost, and clinical effectiveness, routine calcium prophylaxis should be considered as part of standardized postoperative care. Further prospective multicenter trials are warranted to validate these findings.