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DOI: 10.1055/s-2006-956504
© Georg Thieme Verlag KG Stuttgart · New York
Calcitriol Plus Hydrochlorothiazide Prevents Transient Post-Thyroidectomy Hypocalcemia
Publication History
Received 26 January 2006
Accepted after revision 12 September 2006
Publication Date:
12 December 2006 (online)
![](https://www.thieme-connect.de/media/hmr/200612/lookinside/thumbnails/10.1055-s-2006-956504-1.jpg)
Abstract
Background: The aim of our double-blinded randomized prospective placebo-controlled study was to test if a week long pre-treatment with hypercalcemic drugs may prevent transient post-thyroidectomy hypocalcemia and reduce hospital stay. Methods: Forty-two patients undergoing total thyroidectomy were randomized into two groups. Group 1: 22 patients treated with calcitriol 1.5 mcg/die plus hydrochlorothiazide; Group 2: 20 patients only treated with placebo (mineral integrates) as control group. Calcium and PTHi serum levels were assayed baseline and the days before and after thyroidectomy. Results: Baseline calcium and PTHi did not differ between the two groups. Pre-surgery calcemia significantly increased in group 1 (p<0.05) while PTHi significantly decreased (p<0.05). Post-surgery calcemia and PTHi further significantly decreased in both groups, hypocalcemia (<2.10 mmol/l) occurring in 1 out of 22 patients in group 1 without symptoms and in 10 out of 20 in controls (20% developing symptoms) (p<0.01). The hospital stay resulted significantly shorter in group 1 (2.4±0.6 days) in respect to the control group (3.6±1.4 days, p<0.05). Conclusion: The administration of calcitriol plus hydrochlorothiazide is able to prevent transient post-thyroidectomy hypocalcemia and to reduce hospital stay.
Key words
Hypocalcemia - tetany - hypoparathyroidism - parathyroidectomy - thyroidectomy
References
- 1 Singer PA, Cooper DS, Daniels GH, Ladenson PW, Greenspan FS, Levy EG, Braverman LE, Clark OH, McDougall IR, Ain KV, Dorfman SG. Treatment guidelines for patients with thyroid nodules and well-differentiated thyroid cancer. American Thyroid Association. Arch Intern Med. 1996; 156 2165-2172
- 2 Rosato L, Avenia N, De Palma M, Gulino G, Nasi PG, Pezzullo L. Complications of total thyroidectomy: incidence, prevention and treatment. Chir Ital. 2002; 54 635-642
- 3 Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Werneau JL, Recadot A, Proyec C. Hypocalcemia following thyroidectomy: incidence and prediction of outcome. World J Surg. 1998; 22 718-724
- 4 Glinoer D, Andry G, Chantrain G, Samil N. Clinical aspects of early and late hypocalcemia after thyroid surgery. Eur J Surg Oncol. 2000; 26 571-577
- 5 Bentrem DJ, Rademaker A, Angelos P. Evaluation of serum calcium levels in predicting hypoparathyroidism after total/near total thyroidectomy or parathyroidectomy. Am Surg. 2001; 67 249-251
- 6 Sturniolo G, Lo Schiavo MG, Tonante A, D'Alia C, Bonanno L. Hypocalcemia and hypoparathyroidism after total thyroidectomy: a clinical biological study and surgical considerations. Int J Surg Invest. 2000; 2 99-105
- 7 Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG, Pelizzo MR, Pezzullo L. Complication of thyroid surgery: analysis of a multicentric on 14934 patients operated on in Italy over 5 years. World J Surg. 2004; 28 271-276
- 8 Schwartz AE, Clark OH, Ituarte P, Lo Gerfo P. Therapeutic controversy. Thyroid surgery: The choice. J Clin Endocrinol Metab. 1998; 83 1097-1105
- 9 Miccoli P, Berti P, Raffaelli M, Conte M, Materazzi G, Galleri G. Minimally invasive video-assisted thyroidectomy. Am J Surg. 2001; 181 567-570
- 10 Specth MC, Romero M, Barden CB, Esposito C, Fahey 3rd TJ. Characteristics of patients having thyroid surgery under regional anaesthesia. J Am Coll Surg. 2001; 193 367-372
- 11 Demirel F, Ozer T, Gurel A, Acun C, Ozdemir H, Tomac N, Unalacak M. Effect of iodine supplementation on goiter prevalence among the pediatric population in a severely iodine deficient area. J Pediatr Endocrinol Metab. 2004; 17 73-76
- 12 Ceccarelli C, Bencivelli W, Vitti P, Grasso L, Pinchera A. Outcome of radioiodine -131 therapy in hyprfunctioning nodules: a 20 years' retrospective study. Clin Endocrinol. 2005; 62 331-335
- 13 Ozbas S, Kocak S, Aydintug S, Cakmak A, Demirkiran MA, Wishart GC. Comparison of the complications of subtotal, near total and total thyroidectomy in the surgical management of multinodular goitre. Endocrinol J. 2005; 52 199-205
- 14 Lepage R, Legare G, Racicot C, Brossard JH, Lapointe R, Dagenais M, D'Amour P. Hypocalcemia induced during major and minor abdominal surgery in humans. J Clin Endocrinol Metab. 2001; 86 1840-1848
- 15 Dhondt A, Vanholder R, Tielemans C, Glorieux G, Waterloss MA, Smet R, Lameire N. Effect of regional citrate anticoagulation on leukopenia, complement activation, and expression of leukocyte surface molecules during hemodialysis with unmodified cellulose membranes. Nephron. 2000; 85 334-342
- 16 Hulter HN. Effects and interrelationships of PTH, Ca2+, vitamin D and P in acid-base homeostasis. Am J Physiol. 1985; 248 739-752
- 17 Wilson RB, Erskine C, Crowe PJ. Hypomagnesiemia and hypocalcemia after thyroidectomy. Prospective study. World J Surg. 2000; 24 722-726
- 18 De Pasquale L, Schubert L, Bastagli A. Post-thyroidectomy hypocalcemia and feasibility of short-stay thyroid surgery. Chir Ital. 2000; 52 549-554
-
19 Wark JD, Stein MS. Hyperparathyroidism and hypoparathyroidism. In: Rakel RE and Bope ET (Eds).
Conn's Current Therapy 54th ed. Philadelphia: WB Saunders, Elsevier Science 2002: 593-599 -
20 Jackson EK. Diuretics. In: Hardman JG, Limbird LE, Molinoff PB, Ruddon RW and Goodman Gilman A (Eds).
Goodman & Gilman's - The Pharmacological Basis of Therapeutics 9th ed. New York: McGraw-Hill, Inc. 1996: 683-704 - 21 Borghi L, Meschi T, Schianchi T, Allegri F, Guerra A, Maggiore U, Novarini A. Medical treatment of nephrolithiasis. Endocrinol Metab Clin North Am. 2002; 31 1051-1064
- 22 Zofkova I, Kancheva RL. The relationship between magnesium and calciotropic hormones. Magnes Res. 1995; 8 77-84
- 23 Zambudio AR, Rodriguez J, Riquelme J, Soria T, Canteras M, Parrilla P. Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery. Ann Surg. 2004; 240 18-25
- 24 Scurry Jr WC, Beus KS, Hollenbeak CS, Stack Jr BC. Perioperative parathyroid hormone assay for diagnosis and management of posthyroidectomy hypocalcemia. Laryngoscope. 2005; 115 1362-1366
- 25 Payne RJ, Hier MP, Tamilia M, Mac Namara E, Young J, Black MJ. Same-day discharge after total thyroidectomy: the value of 6-hour serum parathyroid hormone and calcium levels. Head Neck. 2005; 27 1-7
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