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Use of pre-operative calcium and vitamin D supplementation to prevent post-operative hypocalcaemia in patients undergoing thyroidectomy: a systematic review

Published online by Cambridge University Press:  14 June 2021

A S Khatiwada*
Affiliation:
Department of Otolaryngology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
A S Harris
Affiliation:
Department of Otolaryngology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
*
Author for correspondence: Dr Aagat Sharma Khatiwada, Department of Otolaryngology, Oxford University Hospitals NHS Foundation Trust, OxfordOX3 7LE, UK E-mail: [email protected]

Abstract

Objective

This systematic review aimed to establish the evidence behind the use of pre-operative calcium, vitamin D or both calcium and vitamin D to prevent post-operative hypocalcaemia in patients undergoing thyroidectomy.

Method

This review included prospective clinical trials on adult human patients that were published in English and which studied the effects of pre-operative supplementation with calcium, vitamin D or both calcium and vitamin D on the rate of post-operative hypocalcaemia following total thyroidectomy.

Results

Seven out of the nine trials included reported statistically significantly reduced rates of post-operative laboratory hypocalcaemia (absolute risk reduction, 13–59 per cent) and symptomatic hypocalcaemia (absolute reduction, 11–40 per cent) following pre-operative supplementation.

Conclusion

Pre-operative treatment with calcium, vitamin D or both calcium and vitamin D reduces the risk of post-operative hypocalcaemia and should be considered in patients undergoing total thyroidectomy.

Type
Review Article
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Dr A S Khatiwada takes responsibility for the integrity of the content of the paper

References

Harness, JK, Fung, L, Thompson, NW, Burney, RE, McLeod, MK. Total thyroidectomy: complications and technique. World J Surg 1986;10:781–6CrossRefGoogle ScholarPubMed
Friguglietti, CU, Lin, CS, Kulcsar, MA. Total thyroidectomy for benign thyroid disease. Laryngoscope 2003;113:1820–6CrossRefGoogle ScholarPubMed
Bhattacharyya, N, Fried, MP. Assessment of the morbidity and complications of total thyroidectomy. Arch Otolaryngol Head Neck Surg 2002;128:389–92CrossRefGoogle ScholarPubMed
Mitchell, AL, Gandhi, A, Scott-Coombes, D, Perros, P. Management of thyroid cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 2016;130(suppl 2):S150–60CrossRefGoogle ScholarPubMed
Haugen, BR, Alexander, EK, Bible, KC, Doherty, GM, Mandel, SJ, Nikiforov, YE et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016;26:1133CrossRefGoogle ScholarPubMed
Chadwick, D, Kinsman, R, Walton, P. The British Association of Endocrine and Thyroid Surgeons Fifth National Audit Report. Henley-on-Thames:, British Association of Endocrine and Thyroid Surgeons, 2017Google Scholar
Pattou, F, Combemale, F, Fabre, S, Carnaille, B, Decoulx, M, Wemeau, JL et al. Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg 1998;22:718–24CrossRefGoogle ScholarPubMed
Puzziello, A, Rosato, L, Innaro, N, Orlando, G, Avenia, N, Perigli, G et al. Hypocalcemia following thyroid surgery: incidence and risk factors. A longitudinal multicenter study comprising 2,631 patients. Endocrine 2014;47:537–42CrossRefGoogle ScholarPubMed
Edafe, O, Antakia, R, Laskar, N, Uttley, L, Balasubramanian, SP. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg 2014;101:307–20CrossRefGoogle ScholarPubMed
Seo, ST, Chang, JW, Jin, J, Lim, YC, Rha, KS, Koo, BS. Transient and permanent hypocalcemia after total thyroidectomy: early predictive factors and long-term follow-up results. Surgery 2015;158:1492–9CrossRefGoogle ScholarPubMed
Grainger, J, Ahmed, M, Gama, R, Liew, L, Buch, H, Cullen, RJ. Post-thyroidectomy hypocalcemia: impact on length of stay. Ear Nose Throat J 2015;94:276–81CrossRefGoogle ScholarPubMed
Baldassarre, RL, Chang, DC, Brumund, KT, Bouvet, M. Predictors of hypocalcemia after thyroidectomy: results from the nationwide inpatient sample. ISRN Surg 2012;2012:838614CrossRefGoogle ScholarPubMed
Alhefdhi, A, Mazeh, H, Chen, H. Role of postoperative vitamin D and/or calcium routine supplementation in preventing hypocalcemia after thyroidectomy: a systematic review and meta-analysis. Oncologist 2013;18:533–42CrossRefGoogle ScholarPubMed
Sanabria, A, Dominguez, LC, Vega, V, Osorio, C, Duarte, D. Routine postoperative administration of vitamin D and calcium after total thyroidectomy: a meta-analysis. Int J Surg 2011;9:4651CrossRefGoogle ScholarPubMed
Sterne, JAC, Savović, J, Page, MJ, Elbers, RG, Blencowe, NS, Boutron, I et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019;366:14898Google ScholarPubMed
Rowe, CW, Arthurs, S, O'Neill, CJ, Hawthorne, J, Carroll, R, Wynne, K et al. High-dose preoperative cholecalciferol to prevent post-thyroidectomy hypocalcaemia: a randomized, double-blinded placebo-controlled trial. Clinical Endocrinology 2018;90:343–50CrossRefGoogle ScholarPubMed
Bhettani, MK, Rehman, M, Ahmed, M, Altaf, HN, Choudry, UK, Khan, KH et al. Role of pre-operative vitamin d supplementation to reduce post-thyroidectomy hypocalcemia; cohort study. Int J Surg 2019;71:8590CrossRefGoogle Scholar
Testa, A, Fant, V, De Rosa, A, Fiore, GF, Grieco, V, Castaldi, P. Calcitriol plus hydrochlorothiazide prevents transient post-thyroidectomy hypocalcemia. Horm Metab Res 2006;38:821–6CrossRefGoogle ScholarPubMed
Genser, L, Trésallet, C, Godiris-Petit, G, Li Sun Fui, S, Salepcioglu, H, Royer, C. Randomized controlled trial of alfacalcidol supplementation for the reduction of hypocalcemia after total thyroidectomy. Am J Surg 2014;207:3945CrossRefGoogle ScholarPubMed
Jaan, S, Sehgal, A, Wani, RA, Wani, MA, Wani, KA, Laway, BA. Usefulness of pre- and post-operative calcium and Vitamin D supplementation in prevention of hypocalcemia after total thyroidectomy: a randomized controlled trial. Indian J Endocrinol Metab 2017;21:51–5Google ScholarPubMed
Oltmann, SC, Brekke, AV, Schneider, DF, Schaefer, SC, Chen, H, Sippel, RS. Preventing postoperative hypocalcemia in patients with Graves’ disease: a prospective study. Ann Surg Oncol 2015;22:952–8CrossRefGoogle ScholarPubMed
Malik, MZ, Mirza, AA, Farooqi, SA, Chaudhary, NA, Waqar, M, Bhatti, HW. Role of preoperative administration of vitamin d and calcium in postoperative transient hypocalcemia after total thyroidectomy. Cureus 2019;11:e4579Google ScholarPubMed
Lai, CK, Zainira, WZ, Imisairi, AH, Mazuin, M, Mokhzani, WM, Ikhwan, S et al. Randomized control study using vitamin d in preventing post total thyroidectomy transient hypocalcemia. Surg Chron 2018;23:2630Google Scholar
Docimo, G, Tolone, S, Pasquali, D, Conzo, G, D'Alessandro, A, Casalino, G. Role of pre and post-operative oral calcium and vitamin D supplements in prevention of hypocalcemia after total thyroidectomy. G Chir 2012;33:374–78Google ScholarPubMed
Edafe, O, Prasad, P, Harrison, BJ, Balasubramanian, SP. Incidence and predictors of post-thyroidectomy hypocalcaemia in a tertiary endocrine surgical unit. Ann R Coll Surg Engl 2014;96:219–23CrossRefGoogle Scholar
Wong, C, Price, S, Scott-Coombes, D. Hypocalcaemia and parathyroid hormone assay following total thyroidectomy: predicting the future. World J Surg 2006;30:825–32CrossRefGoogle ScholarPubMed