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| |  Prophylactic Vitamin D, Calcium Reduces Risk of Hypocalcaemia Following Thyroid Surgery: Presented at WCTC By Cameron Johnston TORONTO -- August 12, 2009 -- The use of prophylaxis of hypocalcaemia with calcitriol plus calcium or exclusive calcium is effective following thyroid surgery, according to a study presented here at the World Congress on Thyroid Cancer (WCTC). In a presentation on August 9, Alvaro Sanabria, MD, University de la Sabana, Bogota, Colombia, said that following thyroidectomy, between 5% and 50% of patients will develop hypocalcaemia. However, this could be prevented in the vast majority of cases. "Hypocalcaemia is a very uncomfortable condition … but it is so easy to prevent," he said. The most common symptoms include severe feelings of pins and needles in the hands and feet. At the more extreme end of the spectrum, symptoms may include cardiac arrhythmias, in particular, atrial fibrillation. In a meta-analysis of 4 studies involving 706 patients who received either vitamin D (n = 346), calcium (n = 288), or no supplement (n = 72) prior to, or immediately following, their thyroidectomy, there clearly was a benefit to receiving prophylactic supplements. The rate of hypocalcaemia was 3.8% in patients who received preventive vitamin D each day, and 19.4% for patients who received supplementary oral calcium 3,600 mg/day. Patients who received no additional supplementation were most likely to develop hypocalcaemia, with a rate of 30.6%. Hypocalcaemia can have a detrimental effect on the individual patient, but there is still the risk that some patients will receive too great a dose of supplements, he said. "It's a big question for us -- who do we wean, and how do we wean them. We don't have any way of knowing who will be on this for life. Also, some patients might start to need PTH [parathyroid hormone] because they are becoming hypercalcaemic," Dr. Sanabria said. In most randomised clinical trials, patients received calcium and vitamin D for only 15 days or so following thyroid surgery. It remains to be determined which patients will develop permanent or transient hypocalcaemia. The latter would represent only a small proportion of patient population who would develop the condition, he said. [Presentation title: Routine Postoperative Administration of Vitamin D After Total Thyroidectomy to Prevent Postoperative Hypocalcaemia: Systematic Review of Literature and Cost-Effectiveness Analysis. Abstract O110]
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