title: Postoperative calcium supplementation in patients undergoing thyroidectomy.
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. tswang@mcw.edu
authors.forename: Tracy S
authors.initials: TS
authors.lastname: Wang
authors.forename: Sanziana A
authors.initials: SA
authors.lastname: Roman
authors.forename: Julie A
authors.initials: JA
authors.lastname: Sosa
mesh_terms: D002118:Calcium / Q000097:blood; D002136:Calcium, Dietary / Q000627:therapeutic use*; D019587:Dietary Supplements; D006801:Humans; D006996:Hypocalcemia / Q000175:diagnosis / Q000517:prevention & control*; D010281:Parathyroid Hormone / Q000097:blood; D011182:Postoperative Care; D011237:Predictive Value of Tests; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000097:blood / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects*
chemical_list: D002136:Calcium, Dietary; D010281:Parathyroid Hormone; D002118:Calcium