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Outcome of parathyroid function after total thyroidectomy when calcium supplementation is administered routinely versus exclusively to symptomatic patients: A prospective randomized clinical trial

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Abstract

Purpose

Current guidelines for calcium supplementation for parathyroid function recovery after thyroidectomy are based on low-quality evidence. The present trial compared the effects of oral calcium and vitamin D supplementation on the recovery of parathyroid function when administered routinely or exclusively to symptomatic patients.

Methods

This prospective, randomized, open-label clinical trial analyzed 203 patients who underwent total thyroidectomy and developed hypoparathyroidism on postoperative day 1 (POD1) with median age of 41 years and proportion of women of 77.8%. Participants were randomized to group A (calcium and vitamin D supplementation administered only to symptomatic patients) and group B (routine supplementation). The primary outcome was the incidence of protracted hypoparathyroidism in the two groups. Secondary outcomes included risk factors for postoperative protracted hypoparathyroidism and the incidence of symptomatic hypocalcemia.

Results

The incidence of protracted hypoparathyroidism was not significantly different between group A and group B (11 of 99 vs. 17 of 104, P = 0.280). Parathyroid hormone (PTH) in group B exhibited a better recovery tendency. The incidence of postoperative symptomatic hypocalcemia in group B was significantly lower than group A (26.92% vs. 42.42%, P = 0.020). Independent factors predicting protracted hypoparathyroidism included sex, preoperative serum calcium, and POD1 PTH.

Conclusion

Calcium and vitamin D supplementation administered exclusively to symptomatic patients achieved the same effect on protracted hypoparathyroidism as routine supplementation. However, routine supplementation significantly reduced postoperative hypocalcemia. Extra attention is necessary in female patients with high preoperative serum calcium and patients with low POD1 PTH.

Trial registration

Chinese Clinical Trial Registry (ChiCTR), ChiCTR1900022194. Registered March 30, 2019.

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Data availability

The datasets used and/or analyzed in the current study are available from the corresponding author on reasonable request.

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Author contributions

AP, Su designed the study and reviewed the paper. Z Li and Y Fei analyzed the clinical data and wrote the paper. Z Li, Y Fei, ZH Li, T Wei, and JQ Zhu performed clinical studies. All authors read and approved the final paper.

Funding

This work was supported by the Bethune Charitable Foundation (HZB-20181119-41).

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  1. These authors contributed equally: Zhe Li, Yuan Fei

Authors and Affiliations

  1. Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China

    Zhe Li, Yuan Fei, Zhihui Li, Tao Wei, Jingqiang Zhu & Anping Su

  2. Laboratory of thyroid and parathyroid disease, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China

    Zhe Li, Yuan Fei, Zhihui Li, Tao Wei, Jingqiang Zhu & Anping Su

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Li, Z., Fei, Y., Li, Z. et al. Outcome of parathyroid function after total thyroidectomy when calcium supplementation is administered routinely versus exclusively to symptomatic patients: A prospective randomized clinical trial. Endocrine 75, 583–592 (2022). https://doi.org/10.1007/s12020-021-02921-9

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