Departments of Otolaryngology.
Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Int J Surg. 2023 Jan 1;109(1):13-20. doi: 10.1097/JS9.0000000000000192.
Hypocalcemia is the most common complication following total thyroidectomy. This study aimed to evaluate the efficacy of perioperative combined calcium and vitamin D supplementation compared to postoperative combined calcium and vitamin D supplementation in reducing symptomatic hypocalcemia.
A prospective randomized placebo-controlled trial was carried out in patients undergoing total or completion thyroidectomy from June 2017 to May 2022. Eligible patients were assigned to receive either calcium carbonate and alfacalcidol or placebo 3 days before surgery, and both groups were given calcium carbonate and alfacalcidol for 14 days after surgery. Clinical outcomes (signs and symptoms of hypocalcemia, requirement of intravenous calcium, and medication-induced hypercalcemia) and laboratory results (calcium and parathyroid hormone levels) were compared between the two groups.
One hundred and thirty-four patients were included in the analysis, 68 were in perioperative oral calcium and vitamin D supplementation group, and 66 were in postoperative oral calcium and vitamin D supplementation group. Symptomatic hypocalcemia rates were significantly lower in the perioperative group than in the postoperative group (8.8 and 22.7%, respectively, P=0.033). All symptomatic hypocalcemia cases in the perioperative group occurred in the first 24 hours after surgery. Mean calcium levels were significantly higher in the perioperative group at 24 and 48 hours after surgery. Intravenous calcium requirement rate was lower in the perioperative group but the difference was insignificant (2.9 and 12.1%, P=0.053). Mean parathyroid hormone levels were within the normal range and did not differ between groups. No medication-induced hypercalcemia was detected in either group.
Perioperative oral calcium and vitamin D supplementation significantly decreased the risks of symptomatic and biochemical hypocalcemia compared to postoperative oral calcium and vitamin D supplementation. The perioperative supplementation also shortened the recovery period of symptomatic hypocalcemia to within 24 hours.
低钙血症是甲状腺全切除术后最常见的并发症。本研究旨在评估围手术期联合补充钙和维生素 D 与术后联合补充钙和维生素 D 相比，降低症状性低钙血症的疗效。
2017 年 6 月至 2022 年 5 月，对行甲状腺全切除术或次全切除术的患者进行前瞻性随机安慰剂对照试验。符合条件的患者被分配接受碳酸钙和阿法骨化醇或安慰剂，术前 3 天开始，两组患者术后均接受碳酸钙和阿法骨化醇治疗 14 天。比较两组患者的临床结局（低钙血症的体征和症状、静脉补钙的需求和药物引起的高钙血症）和实验室结果（血钙和甲状旁腺激素水平）。
共纳入 134 例患者，68 例患者接受围手术期口服钙和维生素 D 补充治疗，66 例患者接受术后口服钙和维生素 D 补充治疗。围手术期组的症状性低钙血症发生率明显低于术后组（分别为 8.8%和 22.7%，P=0.033）。围手术期组所有症状性低钙血症均发生在术后 24 小时内。术后 24 小时和 48 小时，围手术期组的血钙水平明显升高。围手术期组静脉补钙的需求率较低，但差异无统计学意义（分别为 2.9%和 12.1%，P=0.053）。两组甲状旁腺激素水平均在正常范围内，且无差异。两组均未发生药物引起的高钙血症。
与术后口服钙和维生素 D 补充相比，围手术期口服钙和维生素 D 补充可显著降低症状性和生化性低钙血症的风险。围手术期补充还将症状性低钙血症的恢复时间缩短至 24 小时内。
