Role of perioperative calcium and vitamin D supplementation in prevention of hypocalcemia after total thyroidectomy

Abstract

Background: Thyroid surgery is one of the most frequently performed surgical procedures worldwide. Total thyroidectomy is a recommended procedure for most of the thyroid diseases. The most common complication resulting after this surgery is transient hypocalcemia - the incidence is 24% - which increases the morbidity rate and increases the length of stay in the hospital. Objective: The aim of the present randomized controlled trial was to ascertain the usefulness of pre- and post-operative calcium and Vitamin D supplementation in prevention of hypocalcemia after total thyroidectomy. Materials and Methods: It was a prospective randomized controlled study conducted at Department of Surgery, Derna Teaching Hospital, Libya from February 2018 to august 2019. A total of 100 patients of both genders undergoing total thyroidectomy were included in the study, Patients undergoing reoperation for thyroid disease, American Society of Anesthesiologists (ASA) grade 3 or above, patients with chronic renal failure were excluded. The patients were sorted into two groups by lottery method; Group 1 received oral calcium (500 mg every 6 h) and Vitamin D (calcitriol 0.25 mcg every 6 h) 3 days before and 7 days after the surgery; and Group 2 did not receive supplementation. Total thyroidectomy was done and Calcium profile was measured pre- and post-operatively at 6, 12, 24, 48, 72 h, and on 30th day. Hypocalcemia after surgery was either symptomatic or laboratory documented. Serum calcium level ≤ 8.5 mg/dl was considered as laboratory hypocalcemia. The final outcome was measured at one month. Data was analyzed via the Statistical Package for Social Sciences version 22.0 (IBM Corp, Armonk, NY, USA). P value ≤ 0.05 was considered significant.Results: More patients from Group 2 than patients from Group 1 developed symptomatic hypocalcemia (P < 0.01) clearly at 48h and 72h times. Laboratory hypocalcemia within postoperative 24 h was comparable between two groups, but more patients of Group 2 compared to Group 1 developed hypocalcemia at 48 h (10 and 21 respectively; P = 0.04) and at 72 h after surgery (13 and 23 respectively; P = 0.01). Preoperative serum calcium was only independent variable significantly associated with development of 24 h post-operative hypocalcemia.Conclusion: Routine pre- and post-TT calcium and Vitamin D supplementation can significantly reduce postoperative hypocalcemia. Which ultimately can also decrease prolonged hospitalization of patients and costs associated with multiple blood sampling.