Randomized study on oral administration of calcitriol to prevent symptomatic hypocalcemia after total thyroidectomy.
BACKGROUND
Symptomatic hypocalcemia remains the main postoperative complication after total thyroidectomy. The aim of the present study was to evaluate the role of oral supplementation of calcitriol and calcium salts in preventing severe postoperative hypocalcemia after total thyroidectomy.


METHODS
A consecutive series of patients undergoing total thyroidectomy followed by administration of 500 mg of calcium salts 3 times per day were randomized to 3 different postoperative medical treatments: in group A, .5 microg of calcitriol twice per day was administered to 104 patients; in group B, 1 mmicrog of calcitriol twice per day was administered to 111 patients; and in group C, 202 patients did not receive calcitriol.


RESULTS
The rate of postoperative tetany in group A was 2.9%, in group B was 0%, and in group C was 7.4% (P=.03) and the rate of paresthesias was 28.8%, 17.1%, and 22.3%, respectively (P=.19). At discontinuation of calcitriol/calcium salts treatment, intact parathyroid hormone levels did not significantly differ from the preoperative levels. Receiver operating characteristic (ROC) curve analysis showed that the area under the curve for serum concentration of calcium in predicting postoperative tetany was .749, .858 and .862 on the first, second, and third postoperative day, respectively. The best cut-off value of calcemia for prediction tetany was 7.5 mg/dL, and the rate of severe hypocalcemia on the third postoperative day was 23.1% in group A, 9.9% in group B, and 27.2% in group C (P=.001).


CONCLUSIONS
Oral administration of 1 microg of calcitriol twice per day and 500 mg of calcium salts 3 times per day after total thyroidectomy significantly decreases the risk of severe postoperative hypocalcemia.
Tartaglia
Francesco
F
Department of Surgical Sciences, University "La Sapienza," Rome, Italy.
Giuliani
Alessandro
A
Sgueglia
Monica
M
Biancari
Fausto
F
Juvonen
Tatu
T
Campana
Francesco P
FP
D000284:Administration, Oral; D000328:Adult; D002117:Calcitriol / Q000008:administration & dosage*; D002118:Calcium / Q000097:blood / Q000627:therapeutic use; D002120:Calcium Channel Agonists / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010292:Paresthesia / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012372:ROC Curve; D018709:Statistics, Nonparametric; D013746:Tetany / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control; D013965:Thyroidectomy
D002120:Calcium Channel Agonists; D002117:Calcitriol; D002118:Calcium