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Horm Metab Res 2006; 38(12): 821-826
DOI: 10.1055/s-2006-956504
Original Clinical

© Georg Thieme Verlag KG Stuttgart · New York

Calcitriol Plus Hydrochlorothiazide Prevents Transient Post-Thyroidectomy Hypocalcemia

A. Testa 1 , V. Fant 2 , A. De Rosa 3 , G. F. Fiore 2 , V. Grieco 2 , P. Castaldi 2 , R. Persiani 3 , S. Rausei 3 , D. D'ugo 3 , G. De Rosa 2
  • 1Department of Emergency Medicine, A. Gemelli University Hospital, Rome, Italy
  • 2Department of Internal Medicine, A. Gemelli University Hospital, Rome, Italy
  • 3Department of Surgery, A. Gemelli University Hospital, Rome, Italy
Further Information

Publication History

Received 26 January 2006

Accepted after revision 12 September 2006

Publication Date:
12 December 2006 (online)

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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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 8 Schwartz AE, Clark OH, Ituarte P, Lo Gerfo P. Therapeutic controversy. Thyroid surgery: The choice.  J Clin Endocrinol Metab. 1998;  83 1097-1105
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 16 Hulter HN. Effects and interrelationships of PTH, Ca2+, vitamin D and P in acid-base homeostasis.  Am J Physiol. 1985;  248 739-752
    PubMedGoogle Scholar
  • 17 Wilson RB, Erskine C, Crowe PJ. Hypomagnesiemia and hypocalcemia after thyroidectomy. Prospective study.  World J Surg. 2000;  24 722-726
    CrossrefPubMedGoogle Scholar
  • 18 De Pasquale L, Schubert L, Bastagli A. Post-thyroidectomy hypocalcemia and feasibility of short-stay thyroid surgery.  Chir Ital. 2000;  52 549-554
    PubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 22 Zofkova I, Kancheva RL. The relationship between magnesium and calciotropic hormones.  Magnes Res. 1995;  8 77-84
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar

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