Efficacy and safety of prophylactic intravenous calcium supplementation in patients with secondary hyperparathyroidism after parathyroidectomy: a retrospective study.

Prophylactic intravenous calcium supplementation significantly reduced the incidence of severe hypocalcemia after parathyroidectomy in SHPT patients.

• The incidence of severe hypocalcemia in group A (prophylactic intravenous calcium) was 31.9% (30/94 cases) compared to 61.3% (19/31 cases) in group B (non-prophylactic) (P = 0.004).
• The study was retrospective, covering 125 patients with SHPT who underwent PTX between January 2020 and December 2023.
• Group A comprised 94 cases and group B comprised 31 cases.

Non-prophylactic intravenous calcium supplementation, high preoperative PTH, high preoperative ALP, and low preoperative serum calcium were identified as risk factors for severe hypocalcemia.

• Binary logistic regression analysis was used to identify these risk factors.
• Four independent risk factors were identified: non-prophylactic intravenous calcium supplementation, high level of preoperative parathyroid hormone (PTH), high level of alkaline phosphatase (ALP), and low level of preoperative serum calcium.
• These findings suggest that patients with more severe metabolic bone disease preoperatively are at higher risk of postoperative severe hypocalcemia.

Preoperative high level of ALP was identified as a negative predictor for hypercalcemia after calcium supplementation.

• Binary logistic regression analysis revealed that high preoperative ALP was a negative predictor for hypercalcemia following calcium supplementation.
• This finding suggests that patients with elevated ALP (indicative of high bone turnover) are less likely to develop hypercalcemia after calcium supplementation, as the bones act as a sink for supplemented calcium.
• This relationship was identified specifically in the context of intravenous calcium supplementation after PTX.

Prophylactic intravenous calcium supplementation did not substantially increase the risk of hypercalcemia.

• The study concluded that prophylactic intravenous calcium supplementation with dynamic dosage adjustments based on serum calcium levels did not substantially increase the risk of hypercalcemia.
• The protocol included routine oral calcium and calcitriol supplementation in addition to intravenous calcium.
• Dosage adjustments were made dynamically based on serum calcium levels, which was emphasized as an important safety measure.

Severe hypocalcemia is a common complication in SHPT patients after parathyroidectomy, and the necessity and strategy for prophylactic intravenous calcium supplementation has been controversial.

• The study was motivated by ongoing controversy regarding whether prophylactic intravenous calcium supplementation is necessary postoperatively.
• 125 patients with SHPT who underwent PTX between January 2020 and December 2023 were included in the retrospective review.
• Baseline characteristics, laboratory data, and surgical outcomes were compared between the two groups.