title: Usefulness of pre- and post-operative calcium and Vitamin D supplementation in prevention of hypocalcemia after total thyroidectomy: A randomized controlled trial.
abstract: BACKGROUND
  Total thyroidectomy (TT) is a commonly performed surgery and postoperative hypocalcemia is a major detriment to early discharge. The aim of this randomized controlled trial was to ascertain the usefulness of routine pre- and post-operative calcium and Vitamin D supplementation in prevention of hypocalcemia after TT.
  
  
  METHODS
  Sixty consecutive patients who underwent total or near TT from February 2013 to August 2014 were included in the study. They were randomly divided into two groups - Group 1 received oral calcium (500 mg every 6 h) and Vitamin D (calcitriol 0.25 mcg every 6 h) 7 days before and 7 days after the surgery; and Group 2 did not receive supplementation. Symptoms and signs of hypocalcemia were monitored. Calcium profile was measured pre- and post-operatively at 6, 12, 24, 48, 72 h, and on 30thday. Hypocalcemia after surgery was either symptomatic or laboratory documented. Serum calcium level ≤ 8.5 mg/dl was considered as laboratory hypocalcemia.
  
  
  RESULTS
  Twelve patients from Group 2, and 3 patients from Group 1 developed symptomatic hypocalcemia (P< 0.01). Laboratory hypocalcemia within postoperative 24 h was comparable between two groups, but more patients of Group 2 compared to Group 1 developed hypocalcemia at 48 h (6 and 13, respectively;P= 0.04) and at 72 h after surgery (5 and 14, respectively;P= 0.01). Twenty-four hours postoperative serum calcium level was significantly associated with grade of goiter, preoperative calcium, and nature of thyroid disease (benign or malignant). On multiple linear regression analysis, preoperative serum calcium was only independent variable significantly associated with development of 24 h post-TT hypocalcemia.
  
  
  CONCLUSIONS
  Routine pre- and post-TT calcium and Vitamin D supplementation can significantly reduce postoperative hypocalcemia.
authors.affiliation: Department of General and Minimal Access Surgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
authors.forename: Sumiya
authors.initials: S
authors.lastname: Jaan
authors.affiliation: Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Sehgal
authors.affiliation: Department of General and Minimal Access Surgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
authors.forename: Rauf Ahmad
authors.initials: RA
authors.lastname: Wani
authors.affiliation: Department of General and Minimal Access Surgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
authors.forename: Muneer Ahmad
authors.initials: MA
authors.lastname: Wani
authors.affiliation: Department of General and Minimal Access Surgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
authors.forename: Khursheed Alam
authors.initials: KA
authors.lastname: Wani
authors.affiliation: Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
authors.forename: Bashir Ahmad
authors.initials: BA
authors.lastname: Laway
keywords: Calcium supplementation; Vitamin D supplementation; postoperative hypocalcemia; thyroidectomy