Single-dose preoperative vitamin D and calcium supplementation to prevent hypocalcemia after total thyroidectomy: a comparative clinical trial

Abstract

Background Hypocalcemia is not a rare complication after total thyroidectomy. It may be predisposed by preoperative low serum calcium, malignancy, prolonged surgery, inexperienced surgeons, inappropriate use of diathermy, and lack of loop magnifier during surgery. It causes patient distress and may prolong hospital admission time. Calcium and vitamin D administration may help decrease its rate. Patients and methods Two groups of patients undergoing total thyroidectomy were included. Each group included 43 patients. One group was given a single dose of calcium 3 g and vitamin D 40 000 IU on the preoperative day (supplementation group), and no calcium or vitamin D was given to the other group (non-supplementation group). Patients were monitored for clinical hypocalcemia and serum calcium level at 6, 12, 24, and 48 postoperative hours, as well as postoperative vitamin D level and serum calcium after 1 month. Results In the supplementation group, the authors reported three cases of clinical hypocalcemia and seven cases of laboratory hypocalcemia. In the nonsupplementation group, the authors reported 19 patients with laboratory hypocalcemia and 10 patients with clinical hypocalcemia, with significant difference between groups. Postoperative calcium and vitamin D levels were significantly higher in the supplementation group. Conclusion A single-dose preoperative calcium and vitamin D administration is effective in prevention of postoperative hypocalcemia after total thyroidectomy, especially in simple cases. Complicated and malignant cases may need postoperative calcium administration.