To compare selective calcium and calcitriol supplementation guided by early postoperative parathyroid hormone levels with routine prophylactic supplementation in preventing symptomatic hypocalcemia after total thyroidectomy.
Key Findings:
Symptomatic hypocalcemia occurred in 24 of 258 patients (9%).
Rates of symptomatic hypocalcemia were 8% in the parathyroid hormone–guided group and 11% in the routine supplementation group.
Mean symptom scores did not differ between groups at 48 hours and 15 days.
Biochemical hypocalcemia at 15 days occurred in 22% of the parathyroid hormone group and 18% of the routine group.
Selective strategy reduced the proportion of patients receiving supplementation by about 65 percentage points compared to routine therapy.
Interpretation:
Selective calcium and calcitriol supplementation based on early postoperative PTH levels did not provide a significant advantage over routine supplementation in preventing symptomatic or biochemical hypocalcemia.
Limitations:
Lack of blinding in the study.
Modification of the symptom questionnaire without formal psychometric validation in Spanish.
Interinstitutional variability in parathyroid hormone assays.
Absence of some hypocalcemia risk variables.
Reliance on subset analysis for biochemical outcomes.
Conclusion:
Selective C+C supplementation guided by postoperative PTH levels was not superior to routine prophylactic C+C for preventing symptomatic or biochemical hypocalcemia after total thyroidectomy.
