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VOLUME 14 , ISSUE 1 ( January-April, 2022 ) > List of Articles

Original Article

Role of Preoperative Calcium and Vitamin D Supplementation in Preventing Post-total Thyroidectomy Hypocalcemia

MV Sasi, M Shreyamsa, Surabhi Garg, Loreno Enny, Kul R Singh, Chanchal Rana

Keywords : Postoperative hypocalcemia, Thyroidectomy, Vitamin D deficiency

Citation Information : Sasi M, Shreyamsa M, Garg S, Enny L, Singh KR, Rana C. Role of Preoperative Calcium and Vitamin D Supplementation in Preventing Post-total Thyroidectomy Hypocalcemia. World J Endoc Surg 2022; 14 (1):7-14.

DOI: 10.5005/jp-journals-10002-1421

License: CC BY-NC 4.0

Published Online: 16-07-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Introduction: Thyroidectomy is the commonest endocrine surgical procedure. Transient hypocalcemia occurs in the range of 19–38%. Though many parameters are being attributed to postthyroidectomy hypocalcemia, preoperative vitamin D and calcium supplementation seem to be debated. The objective of this study was to find out the benefits of preoperative calcium and vitamin D supplement in preventing postthyroidectomy hypocalcemia. Subjects and methods: This was a prospective randomized study conducted from 1st April 2018 to 31st July 2019. Total thyroidectomy (TT) was performed in all patients for various thyroid disorders. Group A received no preoperative supplements and group B received 6 weeks 2 gm calcium carbonate with weekly cholecalciferol 60,000 units for 6 weeks before surgery. The preoperative biochemical panel, bone mineral density, intraoperative factors, postoperative blood parameters, and clinical effects were analyzed. Results: Of 133 patients who underwent TT in the above period, 83 patients were included in the study, group A (n = 42) and group B (n = 41). Mean age was 41.6 ± 13.39 years (range: 18–74). Female:male was 11:1. Clinical hypocalcemia occurred in 37.3% (n = 31), group A (n = 19) vs group B (n = 12) (p = 0.197). Vitamin D deficiency was seen in 74.7% (n = 62), group A 76.2% (n = 32) vs group B 73.2% (n = 30) (p = 0.804). Postoperative calcium levels were significantly correlated to preoperative magnesium (r = 0.222, p = 0.043), and postoperative day (POD)-1 parathyroid hormone (PTH) levels (r = 0.219, p = 0.047). On multiple linear regression analysis, both were not statistically significant with preoperative magnesium levels (β = 0.194, p = 0.077) and POD-1 PTH (β = 0.190, p = 0.083). The number of parathyroid glands visualized was the only significant independent variable in a separate multiple linear regression analysis (β = 0.598, p = 0.019). When the number of parathyroid glands visualized was less than two, the hypocalcemia increased with an odds ratio (OR) 1.132, 95% confidence interval: 0.068–18.719. Conclusion: Preoperative calcium and vitamin D supplementation did result in lowering post-TT hypocalcemia and hospital stay.

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