title: Selectively predictive calcium supplementation using NCCN risk stratification system after thyroidectomy with differentiated thyroid cancer.
abstract: BACKGROUND
  Hypocalcemia is a common complication following thyroidectomy. To explore reasonable and simple methods for predicting postoperative hypocalcemia and identify the optimal strategies for selective calcium supplement are meaningful for surgeon.
  
  
  METHODS
  Based on the NCCN risk stratification system, patients were divided into 4 groups (A-D): low-risk group A, who only underwent limited thyroidectomy (LT) and high-risk groups B, C and D, who had received total thyroidectomy (TT) and selective central and/or lateral neck dissection (SND). After surgery, group C patients were orally given calcium gluconate and group D patients were intravenously given calcium 2 g/day for 7 days, while group B patients did not receive any calcium supplement. Serum calcium and parathyroid hormone (PTH) levels were collected before and after surgery. The incidence of asymptomatic and symptomatic hypocalcemia in each group was recorded.
  
  
  RESULTS
  A total of 132 patients with differentiated thyroid carcinoma (DTC) were included who received surgical treatment. No a significant change was observed in serum calcium and PTH levels in group A, while significant decreases in serum calcium and PTH levels were seen in group B (P < 0.05). Intravenous calcium supplement in group D resulted in a more rapid recovery in serum calcium levels (P < 0.05). The incidences of symptomatic hypocalcemia and asymptomatic hypocalcemia were significantly lower in group A and group D respectively compared to the other groups (All P values < 0.05). In group B, a highest asymptomatic and symptomatic hypocalcemia incidence was detected.
  
  
  CONCLUSIONS
  Selective calcium supplementation for DTC based on NCCN risk stratification system could be recommended for the high-risk patients.
authors.affiliation: Department of Head and Neck Surgery, Sichuan Cancer Hospital Chengdu 610041, China.
authors.forename: Ronghao
authors.initials: R
authors.lastname: Sun
authors.affiliation: Department of General Surgery, Hebei General Hospital Shijiazhuang 050051, Hebei, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, Hebei General Hospital Shijiazhuang 050051, Hebei, China.
authors.forename: Fenghua
authors.initials: F
authors.lastname: Zhang
authors.affiliation: Department of Head and Neck Surgery, Sichuan Cancer Hospital Chengdu 610041, China.
authors.forename: Jinchuan
authors.initials: J
authors.lastname: Fan
authors.affiliation: Department of Radiology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Yuan
authors.affiliation: Department of Head and Neck Surgery, Sichuan Cancer Hospital Chengdu 610041, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Li
keywords: Differentiated thyroid carcinoma; calcium supplement; complication; hypocalcemia