title: Total thyroidectomy without prophylactic central neck dissection combined with routine oral calcium and vitamin D supplements: is it a good option to achieve a low recurrence rate avoiding hypocalcemia? A retrospective study.
abstract: OBJECTIVE
  Routine central neck dissection for differentiated thyroid cancer (DTC) to prevent a future recurrence is still a matter of discussion, due to the increased risk of injury to parathyroid glands, without a clear demonstrable benefits in terms of long-term survival. Aim of this study was to investigate if, treating patients with total thyroidectomy (TT) without prophylactic central lymphadenectomy can minimize the risk of hypocalcemia by routine administration of oral calcium and vitamin D supplements, providing at the same time a low recurrence rate.
  
  
  METHODS
  In the set of a retrospective study, 221 patients affected by DTC were enrolled. All of them underwent to TT without prophylactic central lymphadenectomy. In the early postoperative period, oral calcium 2g/d taken twice (1 g every 12 hours) and vitamin D 1 g/d taken twice (0.5 g every 12 hours) were administered; changes in serum calcium and hypocalcemia-related symptoms were recorded. Follow-up was based on neck ultrasound and monitoring of serum Tg and Tg-antibodies levels every 6 months during suppressive l-tiroxine treatment.
  
  
  RESULTS
  Symptomatic hypocalcemia developed only in 6.3% of patients, whereas laboratory hypocalcemia developed in 10%. Hypocalcemic symptoms were minimal in 4 patients. Intravenous calcium was administered to 6 patients with severe hypocalcemic symptoms. Permanent hypocalcemia developed in two patients.
  
  
  CONCLUSIONS
  Until a conclusive evidence of the actual benefit of prophylactic central lymphadenectomy in the treatment of DTC, it may be avoided. The oral calcium and vitamin D supplements can take a role in the prevention of postoperative hypocalcemia and for increasing the likelihood of a safe and early discharge from the hospital.
authors.affiliation: Division of General Surgery, Department of Surgery, Second University of Naples, Naples, Italy - docimo@unina2.it.
authors.forename: G
authors.initials: G
authors.lastname: Docimo
authors.forename: S
authors.initials: S
authors.lastname: Tolone
authors.forename: R
authors.initials: R
authors.lastname: Ruggiero
authors.forename: A
authors.initials: A
authors.lastname: Gubitosi
authors.forename: D
authors.initials: D
authors.lastname: Pasquali
authors.forename: A
authors.initials: A
authors.lastname: De Bellis
authors.forename: P
authors.initials: P
authors.lastname: Limongelli
authors.forename: G
authors.initials: G
authors.lastname: Del Genio
authors.forename: L
authors.initials: L
authors.lastname: Docimo
authors.forename: G
authors.initials: G
authors.lastname: Conzo
mesh_terms: D000284:Administration, Oral; D000328:Adult; D002118:Calcium / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000517:prevention & control*; D008197:Lymph Node Excision; D008297:Male; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D014807:Vitamin D / Q000008:administration & dosage*; D014815:Vitamins / Q000008:administration & dosage*
chemical_list: D014815:Vitamins; D014807:Vitamin D; D002118:Calcium