Routine Calcium and Vitamin D Supplement Post Total Thyroidectomy Patients, Does It Worth? Prospective Randomized Study

Research Article

Austin J Surg. 2019; 6(22): 1222.

Routine Calcium and Vitamin D Supplement Post Total Thyroidectomy Patients, Does It Worth? Prospective Randomized Study

Abouelnagah G1, Ali RF2*, Ahmed SF1 and Fouad SM1

¹Department of General Surgery, Faculty of Medicine, Alexandria University, Egypt

²Department of General Surgery, Faculty of Medicine, Kafrelsheikh University, Egypt

*Corresponding author: Reda Fawzy Ali, Kafr El Sheik Faculty of Medicine, 202 Gamal Abdel Naser st, Sidi Bishr, Alexandria, Egypt

Received: September 05, 2019; Accepted: October 23, 2019; Published: October 30, 2019


Background: Thyroidectomy is the most common surgical procedure performed in the neck by surgeons. Hypocalcemia is the most frequent complication after total thyroidectomy, and it is the main cause of prolonged hospital stay. The value of routine postoperative oral calcium and vitamin D supplementation in preventing symptomatic hypocalcemia after total thyroidectomy is still controversy.

Material & Methods: Two hundred and seventy patients who underwent total thyroidectomy for goiters were randomly assigned to routinely receive or not receive oral calcium (3 g/d) and vitamin D (1 μg/d) for 4 weeks post-operatively. Hypocalcemic symptoms, signs, total serum calcium and parathormone levels were monitored and compared between two groups.

Results: The incidence of symptomatic and laboratory hypocalcemia was lower in the group receiving the supplement than in the group not receiving it: 9 of 135 patients (6.7%) versus 45 of 135 (33.3%). The hypocalcemic symptoms were minimal in the group receiving the supplement but more severe in the group not receiving it. Serum calcium levels decreased in both groups after surgery but were lower in the supplemented group.

Conclusion: Routine administration of oral calcium and vitamin D supplementation is effective in reducing the incidence and severity of hypocalcemia after total thyroidectomy.

Keywords: Calcium supplementation; Vitamin D; Hypocalcemia; Thyroidectomy


Thyroidectomy is the most common surgical procedure performed in the neck by surgeons. Theodore Kocher recognized recurrent laryngeal nerve injury, myxedema, and tetany as the three main postoperative complications of thyroidectomy as early as 1883. Tetany was attributed to the deficiency of thyroid gland until Moussu (1898) could relieve it with an aqueous extract of parathyroid glands. Fourman and colleagues (1963) suggested persistent parathyroid insufficiency following transient hypocalcemia [1]. They observed persistent parathyroid insufficiency in 24% of patients after thyroidectomy based on depression of serum ionized calcium level by the ethylene diaminetetraacetic acid (EDTA) infusion test [2].

The immediate manifestations of hypocalcemia are mostly neuromuscular symptoms and occasionally psychotic states. Ectodermal changes leading on to alopecia, eczema, and cataract may occur as early as 6 months after the operation. Persistent hypocalcemia may cause intracranial lesions and cardiac arrhythmias. Permanent hypocalcemia causes a substantial impact on the health of patient along with the considerable financial loss.

The prevention of significant symptomatic hypocalcemia will allow early discharge of post-thyroidectomy patients from the hospital [3]. A combined measurement of iPTH “intact parathyroid hormone” and serum calcium levels is recommended to identify patients at risk for developing hypocalcemia. Severe, progressive hypocalcemia is unlikely with a normal iPTH level, and thus iPTH can be used cautiously to facilitate early discharge for many patients [4].

Routine oral calcium and vitamin D supplements have been proposed to prevent the development of symptomatic hypocalcemia and to increase the likelihood of early hospital discharge after bilateral surgical treatment of the thyroid gland or exploration of the parathyroid glands [5,6].

Materials and Methods

This study included 270 (two hundred and seventy) patients suffering from thyroid enlargement who were admitted to the Department of Surgery at Alexandria and Kafrelsheik University hospitals, during a period from January 2016 to December 2017 excluding those patients suffering from chronic renal failure and parathyroid gland diseases.

All patients included in this study were subjected to complete history taking, full clinical examination, serum T3, T4, TSH, Ultrasound neck. Blood samples were taken from every patient preoperatively as well as postoperatively (days 2, 14, 30) for Serum calcium (total), Parathyroid hormone blood level. All patients in this study were submitted to total thyroidectomy with preservation of the four parathyroid glands. Post-operative histo-pathological details were also collected.

After total thyroidectomy patients were randomized by blind closed envelop technique into 2 groups: Group (A) = 135 patients received routine oral calcium (3gm/day) and oral vitamin D supplementation (alphacalcidol, 1 microgram /day) starting from the first postoperative day and continued for 4 weeks. Group (B) members = 135 patients served as a control group, these patients did not receive any supplementation of calcium or vitamin D.

All patients of both groups (A, B) were observed for any hypocalcemia manifestations as (carpopedal spasm, peri-oral tingling, and numbness). Both patients› groups were informed about the manifestations of hypocalcemia. Serum calcium and serum parathormone level were measured after 48 hours, one month and three months postoperatively.

Chovostek’s sign and trousseau sign were done for every patient on day 2 and 14 of the operation. Statistical analysis was done using the SPSS software package version 17.0 Statistical analysis was done to obtain the mean.


The age of the studied patients ranged from 18-57 years. Among the patients included in this study, 54 cases (20%) were males and 216 cases (80%) were females. Pathological results of all patients with different indicated disease for surgery is shown in (Table 1).

Citation: Abouelnagah G, Ali RF, Ahmed SF and Fouad SM. Routine Calcium and Vitamin D Supplement Post Total Thyroidectomy Patients, Does It Worth? Prospective Randomized Study. Austin J Surg. 2019; 6(22): 1222.