Ann Surg Treat Res.  2019 Apr;96(4):177-184. 10.4174/astr.2019.96.4.177.

Routine low-dose calcium supplementation after thyroidectomy does not reduce the rate of symptomatic hypocalcemia: a prospective randomized trial

• Lee JW
• Kim JK
• Kwon H
• Lim W
• Moon BI
• Paik NS

• KMID: 2442212
• DOI: http://doi.org/10.4174/astr.2019.96.4.177

Abstract

PURPOSE
Routine supplementation of high-dose calcium significantly decreased the risk of postoperative symptomatic hypocalcemia after thyroidectomy. However, there is an ongoing debate about whether the same results can be achieved with low-dose calcium supplementation.
METHODS
Patients (n = 138) who underwent total thyroidectomy for thyroid cancer were 1:1 randomly assigned to receive oral supplements of 1,500 mg/day elemental calcium and 1,000 IU/day cholecalciferol for 2 weeks or no supplementation. Primary objective was to compare the incidence of symptomatic hypocalcemia for 3 days after total thyroidectomy. Secondary objective was to find the predictors for postoperative hypocalcemia in patients with thyroid cancer.
RESULTS
Sixty-five patients in the calcium group and 69 patients in the control group were finally analyzed. The incidence of symptomatic hypocalcemia showed no difference between the calcium and control group (32.3% vs. 21.7%, P = 0.168). The total dosage of intravenous calcium (593.4 ± 267.1 mg vs. 731.6 ± 622.7 mg, P = 0.430) administered to patients with symptomatic hypocalcemia was also comparable between groups. In a multivariate analysis, parathyroid hormone level of 13 pg/mL at postoperative day 1 was only predictive for symptomatic hypocalcemia, and its incidence was 20.9 times (95% confidence interval, 6.8-64.5) higher in patients with parathyroid hormone <13 pg/mL. Other factors did not predict the development of hypocalcemia, including clinicopathological features and routine supplementation of low-dose calcium.
CONCLUSION
Routine low-dose calcium supplementation did not reduce the risk of postoperative hypocalcemia. Patients who may benefit from calcium supplementation should be carefully selected.

Keyword

Calcium; Thyroidectomy; Hypocalcemia; Hypoparathyroidism; Thyroid neoplasms

MeSH Terms

Calcium*
Cholecalciferol
Humans
Hypocalcemia*
Hypoparathyroidism
Incidence
Multivariate Analysis
Parathyroid Hormone
Prospective Studies*
Thyroid Neoplasms
Thyroidectomy*
Calcium
Cholecalciferol
Parathyroid Hormone

Figure

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  Fig. 1 Consolidated standards of reporting clinical trials flow chart.

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