PROPHYLACTIC INFUSION OF CALCIUM SOLUTION REDUCES RISK OF SYMPTOMATIC HYPOCALCEMIA IN PATIENT AFTER TOTAL THYROIDECTOMY

Abstract

Background: Postoperative hypocalcemia is a common and challenging complication of total thyroidectomy, primarily caused by hypoparathyroidism due to inadvertent damage, devascularization, or removal of parathyroid glands. Effective management typically involves monitoring serum calcium levels and administering calcium and/or vitamin D supplementation when hypocalcemia is detected. Prophylactic perioperative calcium supplementation has been suggested as a strategy to prevent symptomatic hypocalcemia and improve recovery outcomes, although its efficacy remains a topic of investigation.

Objective: To assess the effectiveness of prophylactic calcium infusion in reducing the risk of symptomatic hypocalcemia in patients after total thyroidectomy.

Methods: This prospective study included 234 patients who underwent total thyroidectomy, divided equally into two groups. Group A (n = 117) received a prophylactic intravenous calcium infusion (78–156 mg) 2–6 hours postoperatively, while Group B (n = 117) received no prophylactic calcium. Serum calcium (Ca) and intact parathyroid hormone (i-PTH) levels were measured on the first postoperative day, and clinical symptoms of hypocalcemia, including tetany, numbness, and Chvostek's sign, were recorded. Data analysis was performed using SPSS, with chi-square and Spearman’s correlation tests applied. A p-value < 0.05 was considered statistically significant.

Results: Group A demonstrated significantly higher mean serum calcium levels (8.12 ± 0.23 mg/dl) compared to Group B (7.92 ± 0.31 mg/dl; p = 0.015). Tetany occurred in 3.42% of Group A and 11.97% of Group B (p = 0.041), numbness in 15.38% and 26.50% respectively (p = 0.032), and Chvostek's sign in 29.06% and 35.04% respectively (p = 0.87). Recovery from symptomatic hypocalcemia was faster in Group A, with symptoms resolving within 24 hours of surgery. No cases of medication-induced hypercalcemia were observed in either group.

Conclusion: Perioperative prophylactic calcium infusion effectively reduced the incidence of both biochemical and clinical hypocalcemia and shortened the recovery period following total thyroidectomy. These findings underscore its utility as a preventive strategy for postoperative complications.