RT Journal
A1 Landry CS, Grubbs EG, Hernandez M, et al
T1 PRedictable criteria for selective, rather than routine, calcium supplementation following thyroidectomy
JF Archives of Surgery
JO Archives of Surgery
YR 2012
FD April 1
VO 147
IS 4
SP 338
OP 344
DO 10.1001/archsurg.2011.1406
UL http://dx.doi.org/10.1001/archsurg.2011.1406
AB Objectives 
                  To identify patients at risk for symptomatic hypocalcemia and to make recommendations for safe, selective calcium supplementation.Design 
                  Retrospective review of consecutive patients undergoing thyroidectomy. Patients were divided into 2 groups. Group 1 (the “high-risk/calcium-yes” group) included patients who were found to have (1) postoperative symptoms of hypocalcemia (ie, tingling and numbness), (2) any postoperative serum calcium level of less than 7 mg/dL, or (3) a parathyroid hormone level of less than 3 pg/mL on postoperative day 1. Group 2 (the “low-risk/calcium-no” group) included all other patients. Demographic, operative, biochemical, and pathologic data, as well as postoperative calcium supplementation data, were recorded. Trends in serum calcium level and parathyroid hormone level were analyzed during the immediate postoperative period to identify specific factors unique to group 1.Patients 
                  A total of 156 patients who underwent a thyroidectomy.Setting 
                  Tertiary care center.Results 
                  Of the 156 patients reviewed, 78% were female, 70% had a malignant disease, and the median age at operation was 50 years. Thirty-four patients (22%) were in group 1, and 122 patients (78%) were in group 2. Twenty-nine (19%) patients had a parathyroid hormone level of less than 3 pg/mL within 24 hours after a thyroidectomy. Patients who underwent a central neck dissection (P = .001), had malignant disease (P = .01), or had a documented removal of the parathyroid gland (with or without autotransplantation) at operation (P = .013) were most likely to be classified into group 1. Forty-two percent of patients in group 2 had either a parathyroid hormone level of less than 6 pg/mL or a serum calcium level of less than 8 mg/dL on postoperative day 1, but all patients in group 1 who were symptomatic met these parameters.Conclusion 
                  Limiting supplementation to patients with a parathyroid hormone level of less than 6 pg/mL or a serum calcium level of less than 8 mg/dL on postoperative day 1 may eliminate unnecessary calcium/vitamin D intake, phlebotomy, and follow-up assessments in up to 58% of patients undergoing thyroidectomy. Validation is required in a prospective setting.