Abstract
BackgroundTotal thyroidectomy is increasingly used as a surgical approach for many thyroid conditions. Subsequently, postoperative hypocalcaemia is observed with increasing frequency, often resulting in prolonged hospital stay, increased use of resources, reduced quality of life and delayed return to work. The administration of vitamin D is essential in the therapy of postoperative hypocalcaemia; calcitriol is most commonly used. What has not been examined so far is whether and how routine preoperative vitamin D prophylaxis using calcitriol can help to prevent postoperative hypocalcaemia. This study evaluates routine preoperative calcitriol prophylaxis for all patients who are to undergo a total thyroidectomy, compared with the current standard of post-treatment, i.e., selective vitamin D treatment for patients with postoperative hypocalcaemia.Methods/designThis clinical observational (minimal interventional clinical trial) trial is a multicentre, prospective, randomized superiority trial with an adaptive design. Datasets will be pseudonymized for analysis. Patients will be randomly allocated (1:1) to the intervention and the control groups. The only intervention is 0.5 μg calcitriol orally twice a day for 3 days prior to surgery. For the primary endpoint measure (number of patients with hypocalcaemia), hypocalcaemia is defined as serum calcium of less than 2.1 mmol/l on any day during the postoperative course; this measure will be analyzed using a Chi-square test comparing the two groups. Secondary endpoint measures, such as number of days to discharge, quality of life, and economic parameters will also be analyzed.DiscussionBy virtue of the direct comparison of clinically and economically relevant endpoints, the efficacy as well as efficiency of preoperative calcitriol prophylaxis of hypocalcaemia will be clarified. These results should be available 24 months after the first patient has been enrolled. The results will be used to inform a revised practice parameter guideline of whether or not to recommend preoperative calcitriol for all patients in whom total thyroidectomy is planned.Trial registrationDeutsches Register Klinischer Studien, DRKS00005615 (Feb.12.2016).
Highlights
Total thyroidectomy is increasingly used as a surgical approach for many thyroid conditions
Because subtotal thyroidectomy is no longer regarded the treatment of choice for multinodular goitre and Graves’ disease [2], the number of patients treated by total thyroidectomy has progressively increased, amounting to 47.9 % in 2011 [3]
Postoperative symptomatic hypocalcaemia due to transient hypoparathyroidism is a frequent condition after total thyroidectomy, and is reported to occur in up to 54 % of patients [5]
Summary
Total thyroidectomy is increasingly used as a surgical approach for many thyroid conditions. Because subtotal thyroidectomy is no longer regarded the treatment of choice for multinodular goitre and Graves’ disease [2], the number of patients treated by total thyroidectomy has progressively increased, amounting to 47.9 % in 2011 [3]. This surgical approach aims to prevent recurrent disease and is supported by current guidelines, such as the national S2-guideline issued by the Work Group of the Scientific Medical Professional Societies [4]. Risk factors for transient or permanent hypoparathyroidism after total thyroidectomy are higher age, female sex, Graves’ disease, need for parathyroid autotransplantation, inadvertent excision of parathyroid glands and low postoperative parathyroid hormone and serum calcium levels, as well as low preoperative serum 25-hydroxy vitamin D level [6]
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