Keywords
hypocalcemia
calcium supplementation
calcitriol
parathyroid preservation
How to Cite
Abstract
Background: Postoperative hypocalcemia is a common and potentially serious complication following near-total thyroidectomy, primarily due to parathyroid gland trauma or devascularization. Although the prophylactic use of calcium and calcitriol has shown promise in total thyroidectomy, limited evidence exists regarding its utility in near-total procedures.
Methods: This randomized controlled trial was conducted at Holy Family Hospital, Rawalpindi, Pakistan, over six months. A total of 110 adult patients scheduled for near-total thyroidectomy were randomized into two groups: Group A (n=55) received oral calcium carbonate (1000 mg every 8 hours) and calcitriol (0.5 µg every 12 hours) for five days preoperatively, while Group B (n=55) received no supplementation. Postoperative serum calcium levels, intravenous calcium requirement, length of hospital stay, and clinical signs of hypocalcemia were recorded. Statistical analysis was conducted using SPSS v26, with p < 0.05 considered significant.
Results: Transient hypocalcemia occurred significantly less frequently in the intervention group (12.7%) than in the control group (36.4%) (p = 0.004). The need for intravenous calcium was also reduced in Group A (5.5%) compared to Group B (25.5%) (p = 0.006). Fewer patients in Group A required hospitalization longer than two days (7.3% vs. 29.1%, p = 0.003). Age ≥45 years, presence of cardio-metabolic comorbidities, and failure to preserve at least two parathyroid glands were found to be significant predictors of postoperative hypocalcemia, with parathyroid preservation emerging as the strongest risk factor (OR ≈ 19, p < 0.000001).
Conclusion: Preoperative supplementation with calcium and calcitriol significantly reduces the risk of transient hypocalcemia following near-total thyroidectomy. Surgical preservation of at least two parathyroid glands is critical in minimizing hypocalcemia risk. These findings support the adoption of routine prophylactic supplementation protocols in high-risk thyroidectomy patients.