Prevention of postoperative hypocalcemia with routine oral calcium and vitamin D supplements in patients with differentiated papillary thyroid carcinoma undergoing total thyroidectomy plus central neck dissection.
BACKGROUND
Routine oral calcium and vitamin D supplementation may prevent hypocalcemic crisis, but its efficacy has not been studied in patients undergoing thyroidectomy plus central neck dissection (CND). The authors therefore prospectively evaluated the clinical usefulness of routine oral calcium and vitamin D supplementation for prevention of hypocalcemia after total thyroidectomy and CND.


METHODS
Of 197 patients with differentiated papillary thyroid carcinoma, 49 underwent total thyroidectomy alone, and 148 underwent total thyroidectomy plus CND. The latter were randomized to oral calcium (3 g/day) plus vitamin D (1 mg/day) (Group A, n=49), calcium alone (Group B, n=49), or no supplements (Group C, n=50). Hypocalcemic symptoms, serum calcium, and parathyroid hormone (PTH) levels were compared among the groups.


RESULTS
Group C had significantly higher incidences of symptomatic (26.0% vs 6.1%; P<.015) and laboratory (44.0% vs 14.3%; P<.015) hypocalcemia than the group without CND. The incidences of symptomatic and laboratory hypocalcemia were significantly decreased in Groups A (2.0% and 8.2%, respectively) and B (12.2% and 24.5%, respectively) (P<.05). Serum calcium levels decreased in most patients after surgery, but recovered earliest in Group A. Hypercalcemia and PTH inhibition did not occur in gs A and B.


CONCLUSIONS
Compared with total thyroidectomy alone, CND significantly increases the rate of postoperative hypocalcemia, which can be prevented by routine postoperative supplementation with oral calcium and vitamin D.
Roh
Jong-Lyel
JL
Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. rohjl@amc.seoul.kr
Park
Jae-Yong
JY
Park
Chan Il
CI
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood / Q000627:therapeutic use*; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D010281:Parathyroid Hormone / Q000097:blood; D011183:Postoperative Complications; D013964:Thyroid Neoplasms / Q000150:complications* / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects*; D014807:Vitamin D / Q000627:therapeutic use*
D010281:Parathyroid Hormone; D014807:Vitamin D; D002118:Calcium