Does Preoperative Calcium and Calcitriol Decrease Rates of Post-Thyroidectomy Hypocalcemia? A Randomized Clinical Trial.

Abstract

BACKGROUND\nPostoperative hypocalcemia is the most common complication after thyroidectomy. Postoperative supplementation with calcium and calcitriol reduces its occurrence, however, prophylactic preoperative supplementation has not been systematically studied. The primary objective of this study was to determine if pre and postoperative calcium and calcitriol supplementation reduces postoperative hypocalcemia after total thyroidectomy compared to postoperative supplementation alone.\n\n\nSTUDY DESIGN\nSingle institution prospective randomized trial enrolling 82 patients undergoing total thyroidectomy from July 2017 through May 2019. Those undergoing partial thyroidectomy or concurrent planned parathyroidectomy were excluded. The intervention group started calcitriol 0.25mcg PO BID and calcium carbonate 1,500mg PO TID 5 days preoperatively and continued postoperatively. The control group started these medications postoperatively. The primary outcome was clinical or biochemical hypocalcemia. Secondary outcomes were postoperative calcium levels, need for intervention, length of stay and readmission.\n\n\nRESULTS\n38 patients were randomized to the intervention group and 44 to the control group. There were 12 episodes of hypocalcemia; 5 in the intervention and 7 in the control group (5 (13.2%), 7 (15.9%); p= 0.76). No differences were found in secondary outcomes; including postoperative calcium levels at each measured timepoint, need for intervention (10 (26.3%), 15 (34.1%); p = 0.48), length of stay (32.3 hours (15.6), 30.7 hours (SD 10.5); p =0.6) or readmissions (0 (0.0%), 3 (6.8%); p =0.24).\n\n\nCONCLUSION\nStarting supplementation with calcium and calcitriol preoperatively does not reduce postoperative hypocalcemia compared to postoperative supplementation alone after total thyroidectomy. These findings do not support the practice of routine calcium and calcitriol supplementation prior to total thyroidectomy.