Elsevier

Surgery

Volume 132, Issue 6, December 2002, Pages 1109-1113
Surgery

American Association of Endocrine Surgeons
Is routine supplementation therapy (calcium and vitamin D) useful after total thyroidectomy?*

Presented at the 23rd Annual Meeting of the American Association of Endocrine Surgeons, Banff, Alberta, Canada, April 7-9, 2002.
https://doi.org/10.1067/msy.2002.128617Get rights and content

Abstract

Background. Our goal was to determine whether routine oral calcium (OC) and vitamin D (VD) administration can effectively prevent symptoms of hypocalcemia after total thyroidectomy. Methods. Seventy-nine patients who underwent total thyroidectomy were randomly allotted to one of the following groups: (1) group A, no treatment; (2) group B, OC 3 g per day; (3) group C, OC 3 g + VD 1 mg per day. Treatment was started on postoperative (PO) day 1 in groups B and C. Results. Fewer patients in groups B and C experienced symptoms when compared with group A (P =.005). Patients in groups B and C had only minor symptoms, whereas 2 patients in group A experienced major symptoms and 6 required intravenous calcium (P <.01). The rate of hypocalcemia was slightly lower in group C (P = not significant). Treatment was discontinued by PO day 7 in all but 8 patients. Two patients still required treatment 6 months after operation (2.5%). PO parathyroid hormone levels did not differ in the 3 groups (P = not significant). Conclusions. Routine supplementation therapy with OC or VD effectively prevents symptomatic hypocalcemia after total thyroidectomy and may allow for a safe early discharge. Further studies are necessary to determine the best treatment. The combination of OC and VD may further reduce the rate of PO hypocalcemia, without inhibiting parathyroid hormone secretion. (Surgery 2002;132:1109-13.)

Section snippets

Material and methods

Patients who underwent total thyroidectomy between June and September 2001 were included in this study. Previous thyroid or neck operation or irradiation, substernal goiter, concomitant central or lateral neck lymph node dissection, and concomitant parathyroid diseases were considered as exclusion criteria. Patients who underwent video-assisted thyroidectomy were also excluded.

All eligible patients were asked to give their informed consent to be included in the study. The following parameters

Results

Seventy-nine patients were recruited for this study. Group A included 27 patients; groups B and C each had 26 patients. Patient characteristics for the 3 groups are summarized in the Table.The groups were well-matched as for age, sex, preoperative diagnosis, hormonal status, operative time, number of preserved parathyroid glands, and the final histology (Table). The PO stay was 3 days for all the patients because of the study protocol.

The rate of hypocalcemia was similar in group C (6 patients)

Discussion

During the last decade several authors reported the feasibility and safety of thyroid operation on an outpatient basis.13, 14, 15, 16 The possibility of symptomatic hypocalcemia still represents one of the major concerns after bilateral thyroid resection.11, 15, 16 Symptoms usually manifest 24 to 48 hours after operation.14 It is not usually possible to predict which patients are prone to have this complication develop, and thus require OC supplements, VD supplements, or both to avoid

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Reprint requests: Marco Raffaelli, MD, Divisione di Endocrinochirurgia, Istituto di Clinica Chirurgica, Dipartimento di Scienze Chirurgiche, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy.

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