Does Preoperative Calcium and Calcitriol Decrease Rates of Post-thyroidectomy Hypocalcemia? A Randomized Clinical Trial
*Colleen Donahue1, *Haddon Pantel2, *Bharat Yarlagadda1, David Brams1
1Lahey Hospital and Medical Center, Boston, MA;2Yale New Haven Health, New Haven, CT
Objective: Does preoperative supplementation with calcium and vitamin D reduce the occurrence of hypocalcemia after thyroidectomy?
Design: Prospective randomized trial
Setting: Single institution, academic tertiary care center
Patients: Patients undergoing total thyroidectomy from July 2017 to May 2019. 199 patients underwent total thyroidectomy during that time period, 82 of which were consented and randomized. 112 patients were never approached, 1 declined, 3 had surgery at another institution and 1 patient died of unrelated causes prior to undergoing surgery.
Interventions: Intervention group received calcitriol 0.25mcg PO BID and calcium carbonate 1,500mg PO TID starting five days preoperatively, control subjects started the same regimen postoperatively.
Main Outcome Measures: Primary outcome was postoperative hypocalcemia defined as corrected calcium <8.5 or clinical symptoms of hypocalcemia. Secondary outcomes included length of stay and readmission.
Results: 82 patients were enrolled with 38 randomized to the study group and 44 to the control group. The study group had more males (39.5, 18.2; p = 0.048) and was older (59 (15.74), 52 (18.2); p =0.038). There were 12 episodes of postoperative hypocalcemia; five episodes in the study group and seven in the control group (5 (13.2%), 7 (15.9%); p= 0.76). No difference was found in postoperative calcium levels at each time point, need for intervention (10 (26.3%), 15 (34.1%); p = 0.48), length of stay (32.3 (15.6), 30.7 (SD 10.5); p =0.6) or rate of readmission (0 (0.0%), 3 (6.8%); p =0.24). There were no recorded adverse events.
Conclusions: Preoperative supplementation with calcium and calcitriol does not reduce the rate of postoperative hypocalcemia after total thyroidectomy. We did not demonstrate a benefit to routine calcium and vitamin D supplementation prior to total thyroidectomy.
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