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A symptom-based algorithm for calcium management after thyroid surgery: a prospective multicenter study. | LitMetric

AI Article Synopsis

  • The study evaluated a new symptom-based treatment algorithm for managing postthyroidectomy hypocalcemia compared to a traditional biochemically-based approach.
  • The algorithm significantly reduced the number of patients needing calcium and/or alfacalcidol supplementation during the first year and at 12 months follow-up, without severe complications.
  • While there was an increase in calcium-related hospital visits, the findings suggest a need for more personalized treatment strategies based on individual changes in parathyroid hormone levels.

Article Abstract

Objective: Evidence-based treatment guidelines for the management of postthyroidectomy hypocalcemia are absent. The aim of this study was to evaluate a newly developed symptom-based treatment algorithm including a protocolized attempt to phase out supplementation.

Methods: In a prospective multicenter study, patients were treated according to the new algorithm and compared to a historical cohort of patients treated with a biochemically based approach. The primary outcome was the proportion of patients receiving calcium and/or alfacalcidol supplementation. Secondary outcomes were calcium-related complications and predictors for supplementation.

Results: One hundred thirty-four patients were included prospectively, and compared to 392 historical patients. The new algorithm significantly reduced the proportion of patients treated with calcium and/or alfacalcidol during the first postoperative year (odds ratio (OR): 0.36 (95% CI: 0.23-0.54), P < 0.001), and persistently at 12 months follow-up (OR: 0.51 (95% CI: 0.28-0.90), P < 0.05). No severe calcium-related complications occurred, even though calcium-related visits to the emergency department and readmissions increased (OR: 11.5 (95% CI: 4.51-29.3), P <0.001) and (OR: 3.46 (95% CI: 1.58-7.57), P < 0.05), respectively. The proportional change in pre- to postoperative parathyroid hormone (PTH) was an independent predictor for supplementation (OR: 1.04 (95% CI: 1.02-1.07), P < 0.05).

Conclusions: Symptom-based management of postthyroidectomy hypocalcemia and a protocolized attempt to phase out supplementation safely reduced the proportion of patients receiving supplementation, although the number of calcium-related hospital visits increased. For the future, we envision a more individualized treatment approach for patients at risk for delayed symptomatic hypocalcemia, including the proportional change in pre- to post- operative PTH.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10563616PMC
http://dx.doi.org/10.1530/ETJ-23-0044DOI Listing

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