Predictable Criteria for Selective, Rather Than Routine, Calcium Supplementation Following Thyroidectomy

Abstract

Patients with hypocalcemic symptoms, a low parathyroid hormone (PTH) level (1 In some circumstances, parathyroid glands are intentionally removed at operation owing to the close proximity or direct involvement of a malignant tumor. Likewise, parathyroid glands are sometimes inadvertently damaged, devascularized, or removed during the procedure. These injuries may lead to the development of temporary hypoparathyroidism. The actual incidence of temporary hypoparathyroidism reportedly ranges from 1.6% to 50% across different centers.² To protect against symptomatic hypocalcemia after a thyroidectomy, many surgeons routinely discharge patients from the hospital but continue to treat them with calcium supplementation and/or calcitriol, the hormonally active form of vitamin D₃. The routine administration of supplemental calcium and calcitriol can be inconvenient, may lead to unwanted adverse effects such as constipation, and may inhibit PTH production by means of a negative feedback mechanism.³ In addition, the burden of frequent biochemical assessments (ie, of serum calcium and PTH levels) after discharge from the hospital can be demanding for both the patient and the medical team. The aim of our study was to identify patients at risk for developing symptomatic hypocalcemia after completion or total thyroidectomy, and to create recommendations for safe, selective calcium/calcitriol supplementation.