Kosin Med J.  2022 Sep;37(3):213-219. 10.7180/kmj.22.101.

Effectiveness of prophylactic calcium and vitamin D supplementation for preventing post-thyroidectomy hypocalcemia: a meta-analysis

• Moon H
• Seok JW
• Kim K
• Kim HY
• Park MK
• Kim IJ
• Pak K
• Suh S

• KMID: 2538800
• DOI: http://doi.org/10.7180/kmj.22.101

Abstract

Background
Postsurgical hypocalcemia is the most common and troublesome consequence of thyroidectomy. We investigated the potential role of routine calcium or vitamin D supplementation in preventing postsurgical hypocalcemia.
Methods
We searched MEDLINE and Embase for English-language publications using the keywords “calcium,” “vitamin D,” and “thyroid cancer.” The primary outcome was any postoperative hypocalcemia, and the secondary outcome was symptomatic hypocalcemia.
Results
Four studies that included 381 patients were eligible for this meta-analysis. A random-effects model showed no significant difference in the occurrence of hypocalcemia between calcium/vitamin D treatment and placebo/no treatment. However, the occurrence of symptomatic hypocalcemia was lower in patients with calcium/vitamin D treatment. In the combined results, preoperative calcium and vitamin D supplementation were associated with a reduced incidence of symptomatic hypocalcemia.
Conclusions
Our findings support the use of preoperative calcium and vitamin D supplementation in conjunction with routine postsurgical supplementation for patients after total thyroidectomy.

Keyword

Calcium; Hypocalcemia; Thyroid neoplasms; Vitamin D

Figure

• 

  Fig. 1. Flowchart.

• 

  Fig. 2. Forest plot of any postoperative hypocalcemia. Ca, calcium; Vit.D, vitamin D; CI, confidence interval; M-H, Mantel and Haenszel.

• 

  Fig. 3. Forest plot of symptomatic hypocalcemia. Ca, calcium; Vit.D, vitamin D; CI, confidence interval; M-H, Mantel and Haenszel.

Reference

References

1. Cabanillas ME, McFadden DG, Durante C. Thyroid cancer. Lancet. 2016; 388:2783–95.

2. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016; 26:1–133.

3. Dedivitis RA, Aires FT, Cernea CR. Hypoparathyroidism after thyroidectomy: prevention, assessment and management. Curr Opin Otolaryngol Head Neck Surg. 2017; 25:142–6.

4. Orloff LA, Wiseman SM, Bernet VJ, Fahey TJ 3rd, Shaha AR, Shindo ML, et al. American Thyroid Association statement on postoperative hypoparathyroidism: diagnosis, prevention, and management in adults. Thyroid. 2018; 28:830–41.

5. Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg. 2014; 101:307–20.

6. Gafni RI, Collins MT. Hypoparathyroidism. N Engl J Med. 2019; 380:1738–47.

7. Bilezikian JP, Brandi ML, Cusano NE, Mannstadt M, Rejnmark L, Rizzoli R, et al. Management of hypoparathyroidism: present and future. J Clin Endocrinol Metab. 2016; 101:2313–24.

8. Singer MC, Bhakta D, Seybt MW, Terris DJ. Calcium management after thyroidectomy: a simple and cost-effective method. Otolaryngol Head Neck Surg. 2012; 146:362–5.

9. Wang TS, Cheung K, Roman SA, Sosa JA. To supplement or not to supplement: a cost-utility analysis of calcium and vitamin D repletion in patients after thyroidectomy. Ann Surg Oncol. 2011; 18:1293–9.

10. Sanabria A, Dominguez LC, Vega V, Osorio C, Duarte D. Routine postoperative administration of vitamin D and calcium after total thyroidectomy: a meta-analysis. Int J Surg. 2011; 9:46–51.

11. Harslof T, Rolighed L, Rejnmark L. Huge variations in definition and reported incidence of postsurgical hypoparathyroidism: a systematic review. Endocrine. 2019; 64:176–83.

12. Xing T, Hu Y, Wang B, Zhu J. Role of oral calcium supplementation alone or with vitamin D in preventing post-thyroidectomy hypocalcaemia: a meta-analysis. Medicine (Baltimore). 2019; 98:e14455.

13. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003; 327:557–60.

14. Maxwell AK, Shonka DC Jr, Robinson DJ, Levine PA. Association of preoperative calcium and calcitriol therapy with postoperative hypocalcemia after total thyroidectomy. JAMA Otolaryngol Head Neck Surg. 2017; 143:679–84.

15. Jaan S, Sehgal A, Wani RA, Wani MA, Wani KA, Laway BA. Usefulness of pre-and post-operative calcium and vitamin D supplementation in prevention of hypocalcemia after total thyroidectomy: a randomized controlled trial. Indian J Endocrinol Metab. 2017; 21:51–5.

16. Rowe CW, Arthurs S, O'Neill CJ, Hawthorne J, Carroll R, Wynne K, et al. High-dose preoperative cholecalciferol to prevent post-thyroidectomy hypocalcaemia: a randomized, double-blinded placebo-controlled trial. Clin Endocrinol (Oxf). 2019; 90:343–50.

17. Yu YR, Fallon SC, Carpenter JL, Athanassaki I, Brandt ML, Wesson DE, et al. Perioperative determinants of transient hypocalcemia after pediatric total thyroidectomy. J Pediatr Surg. 2017; 52:684–8.

18. Anastasiou OE, Yavropoulou MP, Papavramidis TS, Tzouvara C, Triantafyllopoulou K, Papavramidis S, et al. Secretory capacity of the parathyroid glands after total thyroidectomy in normocalcemic subjects. J Clin Endocrinol Metab. 2012; 97:2341–6.

19. Stack BC Jr, Bimston DN, Bodenner DL, Brett EM, Dralle H, Orloff LA, et al. American Association of Clinical Endocrinologists and American College of Endocrinology disease state clinical review: postoperative hypoparathyroidism--definitions and management. Endocr Pract. 2015; 21:674–85.

20. Park I, Rhu J, Woo JW, Choi JH, Kim JS, Kim JH. Preserving parathyroid gland vasculature to reduce post-thyroidectomy hypocalcemia. World J Surg. 2016; 40:1382–9.

21. Roh JL, Park JY, Park CI. Prevention of postoperative hypocalcemia with routine oral calcium and vitamin D supplements in patients with differentiated papillary thyroid carcinoma undergoing total thyroidectomy plus central neck dissection. Cancer. 2009; 115:251–8.

22. Erbil Y, Barbaros U, Temel B, Turkoglu U, Issever H, Bozbora A, et al. The impact of age, vitamin D(3) level, and incidental parathyroidectomy on postoperative hypocalcemia after total or near total thyroidectomy. Am J Surg. 2009; 197:439–46.

23. Kim WW, Chung SH, Ban EJ, Lee CR, Kang SW, Jeong JJ, et al. Is preoperative vitamin D deficiency a risk factor for postoperative symptomatic hypocalcemia in thyroid cancer patients undergoing total thyroidectomy plus central compartment neck dissection? Thyroid. 2015; 25:911–8.

24. Al Khadem MG, Rettig EM, Dhillon VK, Russell JO, Tufano RP. Postoperative IPTH compared with IPTH gradient as predictors of post-thyroidectomy hypocalcemia. Laryngoscope. 2018; 128:769–74.

25. Shoback D. Clinical practice. Hypoparathyroidism N Engl J Med. 2008; 359:391–403.

26. Lindblom P, Westerdahl J, Bergenfelz A. Low parathyroid hormone levels after thyroid surgery: a feasible predictor of hypocalcemia. Surgery. 2002; 131:515–20.