Calcium and vitamin D reduce hypoparathyroidism and hospital stay after thyroidectomy: A randomized controlled trial.

Prophylactic calcium and vitamin D supplementation significantly reduced laboratory hypocalcemia after total thyroidectomy.

• Laboratory hypocalcemia (serum calcium <8.5 mg/dL) occurred in 16.9% of the supplementation group (group A) versus 39.9% in the standard care group (group B).
• Odds ratio 0.305, 95% confidence interval 0.207–0.451, P < .001.
• The trial enrolled 600 patients randomized equally: group A (n = 300) received prophylactic oral calcium carbonate/gluconate and alfacalcidol; group B (n = 300) received standard postoperative care.
• All patients underwent total thyroidectomy without central neck dissection at a single center.

Prophylactic supplementation significantly reduced symptomatic hypocalcemia after total thyroidectomy.

• Symptomatic hypocalcemia occurred in 5.6% of group A versus 12.3% of group B.
• Odds ratio 0.427, 95% confidence interval 0.232–0.785, P < .005.

Prophylactic supplementation significantly reduced the need for intravenous calcium rescue therapy.

• Intravenous calcium was required in 1.8% of group A versus 9.3% of group B.
• Odds ratio 0.175, 95% confidence interval 0.070–0.441, P < .001.

Patients receiving prophylactic supplementation had higher mean serum calcium levels on postoperative days 1 and 2.

• Group A demonstrated higher mean serum calcium levels on both postoperative day 1 and postoperative day 2 compared to group B (P < .001 for both).
• Serum calcium levels were a secondary outcome of the trial.

Prophylactic calcium and vitamin D supplementation was associated with a significantly shorter hospital stay.

• Mean hospital stay was 1.25 days in group A versus 1.7 days in group B (P < .001).
• Length of hospital stay was a secondary outcome of the trial.
• The authors noted this finding supports reduced health care resource utilization.

The benefits of supplementation were consistent across subgroups defined by malignancy status and preoperative vitamin D levels.

• Subgroup analyses stratified patients by malignancy status (malignant vs. benign thyroid disease) and by preoperative vitamin D levels.
• Supplementation benefits were reported as consistent across all these subgroups.
• This suggests the intervention effect is not limited to specific patient populations.

Transient hypoparathyroidism is a common complication after total thyroidectomy that prolongs hospitalization and necessitates calcium and/or vitamin D replacement.

• The study was motivated by limited evidence from prospective randomized trials on preventive supplementation.
• The trial was designed as a single-center, prospective, randomized, controlled, open-label study.
• Primary outcomes were biochemical and symptomatic hypocalcemia and the need for intravenous calcium; secondary outcomes included postoperative serum calcium levels and length of hospital stay.