Role of Preoperative Vitamin D and Calcium in Preventing Hypocalcemia after Total Thyroidectomy

Background: Total thyroidectomy remains one of the most commonly executed surgical operations. Although generally considered safe, total thyroidectomy carries a risk of surgical complications. Hypocalcaemic tetany is marked by significant spasms in skeletal muscles. Transient hypocalcemia occurs in approximately 30% of cases, while permanent hypocalcemia is reported in about 4%. Administering vitamin D before surgery may reduce both the onset and duration of hypocalcemia. Aim of the study: This research aimed to assess the role of pre-operative oral vitamin D and calcium supplementation in avoiding hypocalcemia and improving postoperative outcomes following total thyroidectomy. Patients and methods: This study included 70 patients treated with total thyroidectomy at Damanhour Teaching Hospital between January 2025 and August 2025. Patients were equally divided into two groups. Group A ( supplementation group) received preoperative oral calcium carbonate and alfacalcidol and Group B (control group) received no preoperative supplements. No prophylactic supplements were administered postoperatively. Patients were observed for clinical manifestations of hypocalcemia. Laboratory hypocalcemia was evaluated at 24 and 48 hours post-surgery. Results: Group A's mean age was 39.23 years, while Group B's mean age was 36.48 years. Postoperative symptomatic hypocalcemia occurred in 8.5% of patients in Group A and in 33.3% in Group B. Severe symptoms requiring intravenous calcium were observed in 2.8% and 12.1% of patients in both groups respectively. Conclusion: Preoperative assessment of calcium level, combined with timely supplementation and early postoperative monitoring was crucial for the management of hypocalcemia following total thyroidectomy.