Does preoperative calcium and calcitriol decrease rates of post-thyroidectomy hypocalcemia? A randomized clinical trial
Colleen Donahue1, Haddon Pantel1, Bharat Yarlagadda1, David Brams1 1Lahey Hospital and Medical Center, Burlington, MA, USA
Background:
Hypocalcemia is the most common complication after thyroidectomy. Although commonly transient it can be severe requiring intervention. Postoperative supplementation with calcium and vitamin D is a standard, evidence based practice. However, expanding supplementation to the preoperative setting has not been well studied. This study examined if preoperative supplementation with calcium and vitamin D reduces the occurrence of hypocalcemia after thyroidectomy compared to postoperative supplementation alone.
Methods:
This was a prospective randomized trial of patients undergoing total thyroidectomy from July 2017 to May 2019. The intervention group received calcitriol 0.25mcg PO BID and calcium carbonate 1,500mg PO TID starting five days preoperatively, control subjects started these medications postoperatively. The primary outcome was postoperative hypocalcemia. Secondary outcomes included length of stay and readmission.
Results:
82 patients were randomized, 38 to the intervention group and 44 to the control group. The intervention group had more males (39.5, 18.2; p=0.048) and was older (59 (15.74), 52 (18.2); p=0.038). There was no difference in postoperative hypocalcemia between groups; five episodes in the intervention group and seven in the control group (5 (13.2%), 7 (15.9%); p=0.76). No difference was found in postoperative calcium levels at each time point, need for intervention (10 (26.3%), 15 (34.1%); p=0.48), length of stay (32.3 (15.6), 30.7 (SD 10.5); p=0.6) or readmission (0 (0.0%), 3 (6.8%); p=0.24).
Conclusion:
Preoperative supplementation with calcium and calcitriol did not reduce the rate of hypocalcemia after thyroidectomy. We did not demonstrate a benefit to routine calcium and vitamin D supplementation prior to total thyroidectomy.
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