Medical College of Wisconsin
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Postoperative calcium supplementation in patients undergoing thyroidectomy. Curr Opin Oncol 2012 Jan;24(1):22-8

Date

11/15/2011

Pubmed ID

22080941

DOI

10.1097/CCO.0b013e32834c4980

Scopus ID

2-s2.0-84869426800 (requires institutional sign-in at Scopus site)   30 Citations

Abstract

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.

Author List

Wang TS, Roman SA, Sosa JA

Author

Tracy S. Wang MPH, MD Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Calcium
Calcium, Dietary
Dietary Supplements
Humans
Hypocalcemia
Parathyroid Hormone
Postoperative Care
Predictive Value of Tests
Risk Factors
Thyroid Neoplasms
Thyroidectomy