Postoperative calcium supplementation in patients undergoing thyroidectomy.

Published

Journal Article

PURPOSE OF REVIEW: Postoperative hypocalcemia is one of the most common complications following thyroidectomy. This review examines recent literature on predictive factors for hypocalcemia, measurement of serum calcium and parathyroid hormone (PTH) levels, and algorithms for supplementation with calcium and/or vitamin D. RECENT FINDINGS: Risk factors for developing postthyroidectomy hypocalcemia include hyperthyroidism, vitamin D deficiency, female sex, substernal thyroid disease, and thyroid cancer, necessitating central neck lymphadenectomy. Several studies have shown that routine postoperative oral calcium and calcitriol supplementation results in lower rates of tetany. Recent studies have focused on the predictive value of intraoperative and postoperative serum PTH levels for the development of symptomatic hypocalcemia. Although the exact timing and serum levels of PTH have been variable, studies have confirmed that patients with very low postoperative PTH levels require oral calcitriol and calcium supplementation. A societal-level cost-utility analysis examining the use of routine vs. selective oral calcium and calcitriol supplementation found that routine supplementation is more cost-effective, and is associated with improved quality of life, irrespective of the surgeons' specific rates of hypocalcemia. SUMMARY: Although some clinicians favor routine supplementation postoperatively, others advocate selective supplementation, guided by postoperative PTH levels. The optimal algorithm is unknown, although a recent cost-analysis study suggests that routine supplementation may be favored at the societal level.

Full Text

Cited Authors

  • Wang, TS; Roman, SA; Sosa, JA

Published Date

  • January 2012

Published In

Volume / Issue

  • 24 / 1

Start / End Page

  • 22 - 28

PubMed ID

  • 22080941

Pubmed Central ID

  • 22080941

Electronic International Standard Serial Number (EISSN)

  • 1531-703X

International Standard Serial Number (ISSN)

  • 1040-8746

Digital Object Identifier (DOI)

  • 10.1097/cco.0b013e32834c4980

Language

  • eng