A prophylactic infusion of calcium solution reduces the risk of symptomatic hypocalcemia in patients after total thyroidectomy.
BACKGROUND
Several risk factors have been associated with post-operative transient hypocalcemia after thyroid surgery. However, there are no studies evaluating preventive measures to avoid symptomatic postoperative hypocalcemia. Although intravenous infusion of calcium improves hypocalcemic symptoms, it is unknown whether prophylactic infusion prevents symptoms of postoperative hypocalcemia.


METHODS
Five hundred and forty-seven patients underwent total thyroidectomy. Two groups were identified: group A (n = 243) received prophylactic intravenous drip infusion of 78-156 mg of calcium solution at 3-8 hours after operation, and group B (n = 304) received no prophylactic treatment. Prophylactic infusion was used only once if the patients did not have symptoms of hypocalcemia. Serum calcium (Ca) levels, intact parathyroid hormone (i-PTH) levels on the first postoperative day (1st POD), and the prevalence of symptoms of hypocalcemia were prospectively analyzed.


RESULTS
The serum Ca levels at the 1st POD in group A patients (7.91 +/- 0.49 mg/dl, mean +/- SD) was significantly higher than group B patients (7.65 +/- 0.54, P < 0.0001), while the serum i-PTH levels were not significantly different between the two groups. The prevalence of numbness and/or tetany before noon on the 1st POD was significantly lower in group A patients. Prophylactic infusion of calcium solution reduced the prevalence of tetany from 8.6% to 2.1%.


CONCLUSIONS
A prophylactic infusion of calcium solution after total thyroidectomy may be useful in reducing the development of symptomatic hypocalcemia and reduces the patients' risk of having discomfort and anxiety due to hypocalcemia.
Uruno
Takashi
T
Department of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori Chuo-ku, Kobe, 650-0011, Japan. uruno@kuma-h.or.jp
Miyauchi
Akira
A
Shimizu
Kazuo
K
Tomoda
Chisato
C
Takamura
Yuuki
Y
Ito
Yasuhiro
Y
Miya
Akihiro
A
Kobayashi
Kaoru
K
Matsuzuka
Fumio
F
Amino
Nobuyuki
N
Kuma
Kanji
K
D002118:Calcium / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012996:Solutions; D018709:Statistics, Nonparametric; D013965:Thyroidectomy; D016896:Treatment Outcome
D012996:Solutions; D002118:Calcium