DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20213889

Prevention of hypoparathyroidism with the use of calcium-rich foods in the total thyroidectomy pre-operative period

Marcelo Jacques Segal, Jose Luis Braga De Aquino, Vania Aparecida Leandro Merhi, Jose Gonzaga Teixeira De Camargo, Paula Srebernich Pizzinato, Joao Paulo Zenun Ramos, Fernando De Almeida Delatti, Felipe Couto Ferreira Rocha, Aline Akel Ferruccio

Abstract


Background: Transient hypocalcemia after total thyroidectomy (TT) is a common surgical complication. Authors used calcium supplements in different doses and periods, mainly after TT to try to avoid hypocalcemia. Indistinct use has been challenged due to complications. Currently, the risk of hypocalcemia was assessed by measuring parathormone (PTH) after TT; however, without a consensus on the best time and amount to consider. The objectives of this study were to evaluate the incidence of hypoparathyroidism with the use of calcium-rich foods in the pre-operative period of TT, followed by a measurement of PTH performed 12 hours after such procedure

Methods: A preliminary study with 31 patients earmarked for TT. Patients were divided into two groups: (A) without calcium-rich foods intake in the TT pre-operative period; and (B) with the intake of calcium-rich foods, in the TT pre-operative period. These foods composing different menus have been suggested, based on the need for daily calcium intake, according to the age group and nutritional data of the Dietary reference intake (DRI). Beginning of the use of these foods has been standardized as being seven days before surgery, due to the slower calcium intestinal absorption process.  

Results: Group B, when compared to A, showed a significant difference between PTH values, before and after surgery (p value <0.001).

Conclusions: Calcium-rich foods intake in the conditions reported may be associated with lower rates of hypoparathyroidism.


Keywords


Calcium, Hypocalcemia, Hypoparathyroidism, Thyroidectomy

Full Text:

PDF

References


Baldassarre RL, Chang DC, Brumund KT, Bouvet M. Predictors of hypocalcemia after thyroidectomy: results from the nationwide inpatient sample. ISRN Surg. 2012;838614.

Bertelli AAT, Kikuchi W, Derito CP, Möller LG, Hirota LM, Garcia VA, et al. Selective treatment of hypoparathyroidism after total thyroidectomy based on PTH values. Rev Bras Cir Cabeça Pescoço. 2014;43(3):123-6.

Dedivitis RA, Pfuetzenreiter EG, Nardi CEM, Duke EC. Prospective Study of Calcemia Fall After Thyroid Surgery. Rev Bras Cir Head Neck. 2009;38(2):72-5.

Fezer GF, Gama RR, Delfes RA. Post-total thyroidectomy parathyroid hormone level as a predictor of symptomatic hypocalcemia- prospective study. Rev Bras Cir Head Neck. 2012;41(2):58-64.

Lira RB, Chulam TC, Kowalski LP. Variations and results of retroauricular robotic thyroid surgery associated or not with neck dissection. Gland Surg. 2018;7(1):42-52.

Eismontas V, Slepavicius A, Janusonis V, Zeromskas P, Beisa V, Strupas K, et al. Predictors of postoperative hypocalcemia occurring after a total thyroidectomy: results of prospective multicenter study. BMC Surg. 2018;18(1):55.

Graciano AJ, Chone CT, Fischer CA. Applicability of immediate, late or serial intact parathyroid hormone measurement following total thyroidectomy. Braz J Otorhinolaryngol. 2012;78(5):78-82.

Jaan S, Sehgal A, Wani RA, Wani MA, Wani KA, Laway BA. Usefulness of pre- and post-operative calcium and Vitamin D supplementation in prevention of hypocalcemia after total thyroidectomy: A randomized controlled trial. Indian J Endocrinol Metab. 2017;21(1):51-5.

Sousa Ade A, Salles JM, Soares JM, Moraes GM, Carvalho JR, Rocha PR. Predictors factors for post-thyroidectomy hypocalcaemia. Rev Col Bras Cir. 2012;39(6):476-82.

Mirkine N, Hooghe L, Geertruyden J, Maertelaer V. Hypocalcemia after thyroidectomy. Arch Surg. 1992;127(7):854-8.

Nair CG, Babu MJ, Menon R, Jacob P. Hypocalcaemia following total thyroidectomy: An analysis of 806 patients. Indian J Endocrinol Metab. 2013;17(2):298-303.

Arer IM, Kus M, Akkapulu N, Aytac HO, Yabanoglu H, Caliskan K, et al. Prophylactic oral calcium supplementation therapy to prevent early post thyroidectomy hypocalcemia and evaluation of postoperative parathyroid hormone levels to detect hypocalcemia: A prospective randomized study. Int J Surg. 2017;38:9-14.

Bellantone R, Lombardi CP, Raffaelli M, Boscherini M, Alesina PF, Crea C, et al. Is routine supplementation therapy (calcium and vitamin D) useful after total thyroidectomy?. Surgery. 2002;132(6):1109-12.

Shinawi M, Anwar A, Nada M, Youssef T, Fakhry E, Raslan S, et al. Oral calcium and vitamin D supplementation after total thyroidectomy Thyroid Res Pract. 2014;11(3):98-102.

Kurukahvecioglu O, Karamercan A, Akin M, Tezel E, Ege B, Taneri F, et al. Potential benefit of oral calcium/vitamin D administration for prevention of symptomatic hypocalcemia after total thyroidectomy. Endocr Regul. 2007;41(1):35-9.

Roh JL, Park CI. Routine oral calcium and vitamin D supplements for prevention of hypocalcemia after total thyroidectomy. Am J Surg. 2006;192(5):675-8.

Tartaglia F, Giuliani A, Sgueglia M, Biancari F, Juvonen T, Campana FP. Randomized study on oral administration of calcitriol to prevent symptomatic hypocalcemia after total thyroidectomy. Am J Surg. 2005;190(3):424-9.

Beall DP, Scofield RH. Milk-alkali syndrome associated with calcium carbonate consumption. Report of 7 patients with parathyroid hormone levels and an estimate of prevalence among patients hospitalized with hypercalcemia. Medicine. 1995;74(2):89-96.

Sabour S, Manders E, Steward DL. The role of rapid PACU parathyroid hormone in reducing post-thyroidectomy hypocalcemia. Otolaryngol Head Neck Surg. 2009;141(6):727-9.

Irvin GL, Dembrow VD, Prudhomme DL. Operative monitoring of parathyroid gland hyperfunction. Am J Surg. 1991;162(4):299-302.

Bourrel C, Uzzan B, Tison P, Despreaux G, Frachet B, Modigliani E, Perret GY. Transient hypocalcemia after thyroidectomy. Ann Otol Rhinol Laryngol. 1993;102(7):496-501.

Scurry WC, Beus KS, Hollenbeak CS, Stack BC. Perioperative parathyroid hormone assay for diagnosis and management of postthyroidectomy hypocalcemia. Laryngoscope. 2005;115(8):1362-6.

Bernadoy C, Lallemant B, Chambon G, Pham HT, Reynaud C, Alovisetti C, et al. Parathyroid Hormone Assays following Total Thyroidectomy: Is There a Predictive Value? Eur Thyroid J. 2018;7(1):34-8.

Rosa KM, Matos LL, Cernea CR, Brandão LG, Araújo FVJ. Postoperative calcium levels as a diagnostic measure for hypoparathyroidism after total thyroidectomy. Arch Endocrinol Metab. 2015;59(5):428-33.

Asari R, Passler C, Kaczirek K, Scheuba C, Niederle B. Hypoparathyroidism after total thyroidectomy: a prospective study. Arch Surg. 2008;143(2):132-7.

Yetkin G, Citgez B, Yazici P, Mihmanli M, Sit E, Uludag M. Early prediction of post-thyroidectomy hypocalcemia by early parathyroid hormone measurement. Ann Ital Chir. 2016;87:417-21.

Lindblom P, Westerdahl J, Bergenfelz A. Low parathyroid hormone levels after thyroid surgery: a feasible predictor of hypocalcemia. Surgery. 2002;131(5):515-20.

Lam A, Kerr PD. Parathyroid hormone: an early predictor of postthyroidectomy hypocalcemia. Laryngoscope. 2003;113(12):2196-200.

Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL. Harrison Medicina Interna. 14th ed. Rio de Janeiro: McGraw-Hill; 1998.

Heaney RP. Calcium intake and disease prevention. Arq Bras Endocrinol Metabol. 2006;50(4):685-93.