Objective: There are no established evidence-based guidelines for managing post-thyroidectomy hypocalcemia. This study aimed to evaluate a newly developed symptom-based treatment algorithm, which includes a structured attempt to phase out calcium and alfacalcidol supplementation.
Methods: This prospective multicenter study compared patients treated using the new algorithm to a historical cohort that received a biochemically based approach. The primary outcome was the proportion of patients receiving supplementation. Secondary outcomes included calcium-related complications and predictors for supplementation.
Results: A total of 134 patients were treated with the new algorithm and compared to 392 historical patients. The symptom-based approach significantly reduced the proportion of patients receiving supplementation both at discharge and after 12 months (P < 0.001 and P < 0.05, respectively). No severe complications occurred, but calcium-related emergency department visits and readmissions increased (P < 0.001 and P < 0.05). The proportional change in pre- to postoperative parathyroid hormone (PTH) was identified as a predictor for supplementation (P < 0.05).
Conclusions: Symptom-based management of post-thyroidectomy hypocalcemia safely reduced unnecessary supplementation, though it resulted in more hospital visits. Future approaches may incorporate individualized treatment strategies based on pre- to postoperative PTH changes.
