Objective:

To compare selective calcium and calcitriol supplementation guided by early postoperative parathyroid hormone levels with routine prophylactic supplementation in preventing symptomatic hypocalcemia after total thyroidectomy.

Approach:

Key Findings:

• Symptomatic hypocalcemia occurred in 24 of 258 patients (9%).
• Rates of symptomatic hypocalcemia were 8% in the parathyroid hormone–guided group and 11% in the routine supplementation group.
• Mean symptom scores did not differ between groups at 48 hours and 15 days.
• Biochemical hypocalcemia at 15 days occurred in 22% of the parathyroid hormone group and 18% of the routine group.
• Selective strategy reduced the proportion of patients receiving supplementation by about 65 percentage points compared to routine therapy.

Interpretation:

Selective calcium and calcitriol supplementation based on early postoperative PTH levels did not provide a significant advantage over routine supplementation in preventing symptomatic or biochemical hypocalcemia.

Limitations:

• Lack of blinding in the study.
• Modification of the symptom questionnaire without formal psychometric validation in Spanish.
• Interinstitutional variability in parathyroid hormone assays.
• Absence of some hypocalcemia risk variables.
• Reliance on subset analysis for biochemical outcomes.

Conclusion:

Selective C+C supplementation guided by postoperative PTH levels was not superior to routine prophylactic C+C for preventing symptomatic or biochemical hypocalcemia after total thyroidectomy.

Sources:

• JAMA Otolaryngology–Head & Neck Surgery
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