Prophylactic vs On-demand Calcium Supplementation after Total Thyroidectomy: A Cohort Study Evaluating Two Different Protocols

IntroductIonPostoperative hypocalcemia resulting from parathyroid dysfunction is the most frequent complication following completion or total thyroidectomy (TT, completion thyroidectomy = a TT performed in multiple sessions), with an incidence between 3 and 64% depending on the definition used. 1 This condition is the result of either inadvertent removal or compromised vascularization of the anatomically related parathyroid glands and is treatable with calcium and/or active vitamin D supplementation.Patients with postoperative hypocalcemia often are hospitalized for a prolonged duration, leading to increased health care costs.Furthermore, postoperative hypocalcemia seems to be a risk factor for persistent hypoparathyroidism, which necessitates extended periods of supplementation and is associated with a reduction in quality of life. [2][3]][4] Post-T T supplementation protocols can be broadly categorized as either prophylactic (proactive) or on-demand (reactive).Proactive protocols involve routine supplementation for all patients to prevent postoperative hypocalcemia and facilitate early discharge, thus reducing healthcare costs.