Calcium, vitamin D supplements key after thyroid surgery, per study
Preventive supplements lower risk of temporary hypoparathyroidism
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Taking calcium and vitamin D supplements as a preventive approach after thyroidectomy, or surgical removal of the thyroid, was found to lower the risk of transient hypoparathyroidism — a temporary condition marked by low blood calcium and low parathyroid hormone (PTH) levels — and to shorten patient hospital stays for participants in a large clinical trial in Greece.
The study results also showed that patients who received these preventive supplements were less likely to experience symptoms such as tingling or muscle cramps. They also had a lesser need for intravenous, or into-the-vein, calcium after surgery, the data showed.
Altogether, according to the researchers, the results of this study support the use of calcium and vitamin D supplements as a postoperative management strategy.
“The findings of this trial demonstrate that a standardized supplementation protocol … reduces transient hypoparathyroidism in a safe, simple … manner, improving patient comfort and facilitating earlier discharge,” the scientists wrote, noting that the use of supplements helped “to enhance recovery and reduce health care resource utilization.”
Titled “Calcium and vitamin D reduce hypoparathyroidism and hospital stay after thyroidectomy: A randomized controlled trial,” the study was published in the journal Surgery.
Hypoparathyroidism is characterized by low levels of PTH, a hormone produced by the parathyroid glands — small glands located in the neck near the thyroid — that helps the body regulate calcium and phosphorus levels. When PTH levels are low, calcium levels decrease (hypocalcemia), leading to most disease symptoms.
Temporary hypoparathyroidism can last for up to 6 weeks after surgery
Transient, or temporary, hypoparathyroidism lasting up to six weeks may occur after thyroidectomy, a surgical procedure to remove the thyroid gland, and prolong a patient’s hospitalization. The condition most commonly occurs due to damage or accidental removal of the parathyroid glands and may include symptoms such as tingling, seizures, and abnormal heart rhythm.
Treatment strategies focus on monitoring of calcium and PTH levels to guide calcium and vitamin D supplementation. Still, whether to use these supplements on demand or as a preventive approach remains a subject of debate, according to the researchers.
One concern is hyperthyroidism, where there’s too much PTH.
To learn more, scientists in Athens conducted an open-label clinical study (NCT03777033) to assess whether preventive calcium and vitamin D supplements may reduce transient hypoparathyroidism and hospital stay after total thyroidectomy.
The trial enrolled 600 people who underwent thyroidectomy, most commonly for benign disease, at the General Hospital of Athens. About three-quarters of the patients were women, and the overall mean age was 53.2 years.
Calcium, vitamin D supplements also found to shorten hospital stays
Participants were randomly assigned to receive no supplements or an oral supplement regimen consisting of 3 g of calcium (carbonate/gluconate) and 1 microgram (mcg) of vitamin D — its active form alfacalcidol — daily for the first five days after surgery, followed by 2 g of calcium and 0.5 mcg for the subsequent 10 days.
Before and on the day after surgery, the patients’ calcium and PTH levels were within the normal range. Within two days, about one-quarter of patients had low calcium levels (lower than 8.5 mg/dL); a total of 8% had mild symptoms, while 5% had severe symptoms that required intravenous calcium. Most patients (71%) had insufficient vitamin D levels, 7% had severe deficiency, and 22% had normal levels.
One day after surgery, patients who did not receive supplements had higher PTH (24.76 vs. 19.44 picograms/mL). Lower calcium levels were seen in this group on the first two days after thyroidectomy. They also had significantly longer mean hospital stays after surgery (1.7 vs. 1.26 days) than the participants who took supplements.
Additionally, a lower proportion of patients who received supplements had low calcium blood levels (17% vs. 40%), experienced symptoms of hypocalcemia (6% vs. 12%), and required intravenous calcium (2% vs. 9%).
By 10 days after the surgery, no significant differences between the two groups persisted in calcium or PTH levels, “reflecting the transient effect of supplementation in the early postoperative period,” the researchers wrote.
One patient developed severe hypercalcemia (high calcium) requiring readmission and clinical management.
Although the mean difference in length of stay was only half a day … it reflects a meaningful shift in discharge patterns, with most supplemented patients discharged on [postoperative day 1], and more nonsupplemented patients requiring prolonged hospitalization.
Supplementation benefits were generally maintained across subgroups of patients who underwent thyroidectomy due to benign disease or cancer diagnosis, and regardless of patients’ vitamin D status before surgery.
The researchers noted that the difference in hospitalization length between patients given supplements and those not receiving vitamin D and calcium ultimately amounted to about one half-day.
Still, the team noted that “in health care systems with bundled reimbursement, even small differences may translate into significant additional costs for a considerable number of patients.” As such, the supplementation strategy results in cost savings, per the researchers.
“Although the mean difference in length of stay was only half a day … it reflects a meaningful shift in discharge patterns, with most supplemented patients discharged on [postoperative day 1], and more nonsupplemented patients requiring prolonged hospitalization,” the team wrote.
