Current Understanding of Post-thyroidectomy Hypocalcaemia

Abstract

Background: The reported incidence of transient hypocalcaemia ranges from 0.3% to 49%, and that of permanent hypocalcaemia ranges from 0% to 13% depending of cutoff used. Decline in serum calcium or intact parathyroid hormone (iPTH) levels after surgery have been suggested as being reliable predictors of postoperative hypocalcaemia. Although these determinants are reliable, it is not always easy to predict status of the patient to decide their discharge or need of need of supplementation

Methods: We have searched for clinical studies in Pub Med on 31/01/2012: with a keyword post Thyroidectomy ‘Hypocalcaemia’. The first inclusion criteria were studies published in year 2002 and 2012. Further we included: Original research; studies Thyroidectomy (total or partial). Also, we narrowed our inclusion with the words: Hypocalcaemia; calcium supplementation alone or in combination; Post-thyroidectomy hypoparathyroidism.

Results: of 149 articles searched demonstrated the heterogeneous nature of symptomatic and biochemical hypocalcaemia because different studies used different cutoffs, some studies have expressed concern regarding the routine use of prophylactic calcium after surgery because a large number of patients are treated unnecessarily. However number of studies showed routine calcium supplementation for patients undergoing total or completion thyroidectomy is safe and inexpensive.

Conclusions: Hypoparathyroidism after thyroidectomy remains the most widely accepted cause of hypocalcaemia. Prophylactic treatment of hypocalcaemia with vitamin D or metabolites + calcium or calcium alone is a cost-effective strategy. JMS 2013; 16(2):75-79