Post-Thyroidectomy Hypocalcemia and Effects of Pre-Operative Calcium   Supplements on its Incidence

Erisha Komal; Muhammad Saeed Akhtar; Khurrum Niaz; Wasif Idris Ahmed; Muhammad Ahsan Mustafa; Muhammad Sauban Raza

doi:10.51253/pafmj.v74i4.10791

Authors

Erisha Komal Department of Surgery, Combined Military Hospital Bahawalpur/National University of Medical Sciences (NUMS) Pakistan
Muhammad Saeed Akhtar Department of Surgery, Combined Military Hospital Bahawalpur/National University of Medical Sciences (NUMS) Pakistan
Khurrum Niaz Department of Surgery, Sheikh Zayed Medical College, Rahim Yar Khan Pakistan
Wasif Idris Ahmed Department of Surgery, Combined Military Hospital Bahawalpur/National University of Medical Sciences (NUMS) Pakistan
Muhammad Ahsan Mustafa Department of Surgery, Combined Military Hospital Bahawalpur/National University of Medical Sciences (NUMS) Pakistan
Muhammad Sauban Raza Department of Surgery, Nishtar Institute of Dentistry, Multan Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74i4.10791

Keywords:

Calcium, Hypocalcemia, Randomized controlled trial, Thyroidectomy.

Abstract

Objective: To determine the effects of pre-operative Calcium supplements on post-total thyroidectomy hypocalcemia.

Study Design: Randomized Control Trial (IRCT Id20231016059739N1).

Place and Duration of Study: Combined Military Hospital Bahawalpur Pakistan, from Sep 2022 to Sep 2023.

Methodology: All the patients undergoing total thyroidectomy and having normal Calcium levels were included. Baseline demographic data, medical history, and pre-operative Calcium levels were recorded for all participants. A total of 105 patients were enrolled in the study, with 52 patients assigned to the intervention group (Group-A) and 53 patients assigned to the control group (Group-B). Group-A was given a Calcium supplement and Group-B was given a placebo. Post-operative follow-up assessments were conducted at designated time points to evaluate serum Calcium levels and monitor for the occurrence of hypocalcemia.

Results: The demographic characteristics, baseline Calcium levels, and surgical procedures were similar between the two groups, ensuring comparability. The mean value of the post-operative Calcium level of the interventional group was 8.904±0.4542 mg/dl and control group was 8.647±0.4964 mg/dl showing statistically significant difference (p-value 0.007). In the Group-A, 8 out of 52 patients (7.6%) developed hypocalcemia, whereas in the Group-B, 20 out of 53 patients (19%) experienced hypocalcemia showing statistically significant difference (p-value 0.009).

Conclusion: Preoperative Calcium supplementation may not only decrease the occurrence of hypocalcemia but also promote a faster recovery from this complication following thyroid surgery.

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References

Brauer PR, Reddy CA, Burkey BB, Lamarre ED. A national comparison of postoperative outcomes in completion thyroidectomy and total thyroidectomy. Otolaryngol Head Neck Surg 2021; 164(3): 566–573.

https://dx.doi.org/10.1177/0194599820951165

Orloff LA, Wiseman SM, Bernet VJ. American Thyroid Association statement on postoperative hypoparathyroidism: diagnosis, prevention, and management in adults. Thyroid 2018; 28(7): 830–841. https://doi.org/10.1089/thy.2017.0309

Qin Y, Sun W, Wang Z, Dong W, He L, Zhang T, et al. A meta-analysis of risk factors for transient and permanent hypocalcemia after total thyroidectomy. Front Oncol 2021; 10: 614089. https://doi.org/10.3389/fonc.2020.614089

Malik MZ, Mirza AA, Farooqi SA, Chaudhary NA, Wagar M, Bhatti HW et al. Role of preoperative administration of vitamin D and Calcium in postoperative transient hypocalcemia after total thyroidectomy. Cureus 2019; 11(4): 4579.

https://doi.org/10.7759/cureus.4579

Konishi T, Fujiogi M, Michihata N, Niwa T, Morita K, Matsui H, et al. Impact of body mass index on short-term outcomes after differentiated thyroid cancer surgery: a nationwide inpatient database study in Japan. Eur Thyroid J 2022; 11(1): e210081.

https://doi.org/10.1530/ETJ-21-0081

Zheng XG, Xu CY. Role of Preoperative Calcium and Vitamin D Supplementation in Preventing Post-total Thyroidectomy Hypocalcemia: a Systematic Review and Meta-analysis. Ind J Surg 2023: 1-10. https://doi.org/10.1007/s12262-023-03896-9

Qin X, Luo J, Ma J, Cao X, Zhao J, Jiang J, et al. Prospective cohort study of parathyroid function and quality of life after total thyroidectomy for thyroid cancer: robotic surgery vs. open surgery. Int J Surg 2023; 109(12): 3974-3982.

https://doi.org/10.1097/JS9.0000000000000725

Del Rio P, Rossini M, Montana CM, Viani L, Pedrazzi G, Loderer T, et al. Postoperative hypocalcemia: analysis of factors influencing early hypocalcemia development following thyroid surgery. BMC Surg 2019; 18(1): 1-8.

https://doi.org/10.1186/s12893-019-0483-y

Maxwell AK, Shonka DC, Robinson DJ, Levine PA. Association of preoperative Calcium and calcitriol therapy with postoperative hypocalcemia after total thyroidectomy. JAMA Otolaryngol Head Neck Surg 2017; 143(7): 679-684.

https://doi.org/10.1001/jamaoto.2016.4796

Arer IM, Kus M, Akkapulu N, Aytac HO, Yabanoglu H, Caliskan K, et al. Prophylactic oral Calcium supplementation therapy to prevent early post thyroidectomy hypocalcemia and evaluation of postoperative parathyroid hormone levels to detect hypocalcemia: a prospective randomized study. Int J Surg 2017; 38: 9-14. https://doi.org/10.1016/j.ijsu.2016.12.041

Zheng XG, Xu CY. Role of Preoperative Calcium and Vitamin D Supplementation in Preventing Post-total Thyroidectomy Hypocalcemia: a Systematic Review and Meta-analysis. Indian J Surg 2023: 1-10. https://doi.org/10.1007/s12262-023-03896-9

Gorbea E, Goldrich DY, Agarwal J, Nayak R, Iloreta AM. The impact of surgeon volume on total thyroidectomy outcomes among otolaryngologists. Am. J. Otolaryngol 2020; 41(6): 102726.

https://doi.org/10.1016/j.amjoto.2020.102726

Abouelnagah G, Ali RF, Ahmed SF, Fouad SM. Routine Calcium and Vitamin D Supplement Post Total Thyroidectomy Patients, Does It Worth. Prospective Randomized Study. Austin J Surg 2019; 6(22): 1222.

Fernando R, Chandrasinghe PC, Bandara M. Hypocalcemia and hoarseness following total thyroidectomy for benign disease: relationship of incidence to the size of the gland. World J Endoc Surg 2013; 3(1): 7-9.

https://doi.org/ 10.5005/jp-journals-10002-1046

Lechner M, Moghul G, Chandrasekharan D, Ashraf S, Emanuel O, Magos T, et al. Preoperative and postoperative optimisation of patients undergoing thyroid surgery: a multicenter quality improvement project at Barts Health NHS Trust. BMJ Open Qual 2023; 12(2): e001190.

https://doi.org/10.1136/bmjoq-2020-001190

Orloff LA, Wiseman SM, Bernet VJ, Fahey lll TJ, Shaha AR, Shindo ML, et al. American Thyroid Association Surgical Affairs Committee Writing Task Force. American Thyroid Association statement on postoperative hypoparathyroidism: diagnosis prevention, and management in adults. Thyroid 2018; 28(7): 830-841.

https://doi.org/10.5005/jp-journals-10002-1421

Sasi MV, Shreyamsa M, Garg S, Enny L, Singh KR, Rana C, et al. Role of Preoperative Calcium and Vitamin D Supplementation in Preventing Post-total Thyroidectomy Hypocalcemia. World J Endoc Surg 2022; 14(1): 7-14.

https://doi.org/10.5005/jp-journals-10002-1421

Ravikumar K, Dhalapathy S, Muthukumar S. A Prospective study on role of supplemental oral Calcium and vitamin D in prevention of post thyroidectomy hypocalcemia. Indian J Endocrinol Metab 2017; 21(4): 498–503.

https://doi.org/10.4103/ijem.IJEM_402_16.