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Calcium Supplementation After Thyroidectomy

More than 50,000 thyroid operations are performed in the United States annually, and postoperative hypoparathyroidism can occur in up to 30% of cases. To protect against the development of symptomatic hypocalcemia that occurs with postoperative hypoparathyroidism, many medical centers routinely discharge patients who have undergone thyroidectomy with prescriptions for calcium supplementation. These supplements, however, can be inconvenient for patients. They may cause adverse events (eg, constipation and nausea) and may actually suppress parathyroid hormone (PTH) production. Patients discharged on calcium replacement after thyroidectomy usually undergo follow-up blood work to test serum calcium and PTH levels, causing loss of productivity for the patient and additional paperwork for the medical staff. Selective calcium supplementation may offer an effective means for eliminating the costs and burden associated with routine supplementation. Selective Calcium Supplementation “With routine calcium supplement use, clinicians must determine when and how to wean patients off supplementation when appropriate,” explains Nancy D. Perrier, MD. “Calcium supplements are relatively inexpensive, but the real burden of routine calcium supplementation comes with the additional laboratory work that is needed. Medical staff must conduct continued follow-up and communicate results to patients. Ultimately, routine supplementation increases the complexity of postoperative care.” On the other hand, according to Dr. Perrier, checking blood calcium levels shortly after thyroidectomy to determine if patients require supplementation allows providers to personalize the postoperative treatment plan with the patient prior to hospital discharge. A New Analysis for Post-Thyroidectomy Dr. Perrier and colleagues had a study published in Archives of Surgery that tested an algorithm for approaching post-thyroidectomy calcium supplementation based on a selective approach. Patients were analyzed during the postoperative period...

Strategies for Treating Hyperparathyroidism

Primary hyperparathyroidism is one of the most common causes of abnormally high blood calcium levels. Medications such as estrogen and bisphosphonates will not cure primary hyperparathyroidism, but may decrease calcium or parathyroid hormone (PTH) levels and improve bone density. Parathyroidectomy is the only known cure for primary hyperparathyroidism and is currently viewed as the optimal treatment strategy. In the hands of experienced endocrine surgeons, success rates approach 95% to 98%, according to available databases. Persistent primary hyperparathyroidism occurs when calcium levels and PTH levels do not return to normal within 6 months of a parathyroid operation. This usually happens because all of the abnormal parathyroid tissue was not removed at the first operation. This may result when inexperienced surgeons miss the diseased gland, in the presence of an ectopic gland located in a difficult-to-find location, or when patients have multiple abnormal glands. “Just because a patient has a hyperparathyroidism does not mean they will need surgery in all cases.” When calcium and PTH levels are initially normal after parathyroid surgery but become abnormal again after 6 months, patients have recurrent primary hyperparathyroidism. This type of hyperparathyroidism usually happens when one or more of the remaining glands become hyperactive. Parathyroid cancer can cause either persistent or recurrent primary hyperparathyroidism, but less than 1% of patients with primary hyperparathyroidism will be diagnosed with parathyroid cancer. Considering Reoperative Parathyroid Surgery Both persistent and recurrent primary hyperparathyroidism may require reoperative parathyroid surgery. Patients who have had significant surgery in the cervical region—particularly total thyroidectomy—should be considered as if they were undergoing a reoperation because they pose technical challenges that have resulted in suboptimal...
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