Erbil et al evaluated risk factors associated with postoperative hypocalcemia following total thyroidectomy for nontoxic multinodular goiter. This can help identify patients who may benefit from calcium or vitamin D supplementation following the operation. The authors are from Istanbul University in Turkey.


Criteria for postoperative hypocalcemia: serum total calcium <= 8.0 mg/dL



(1) age of the patient in years

(2) postoperative parathyroid hormone in pg/mL

(3) preoperative serum 25-hydroxyvitamin D3 in ng/mL


If the preoperative serum 25-hydroxyvitamin D3 is < 15 ng/mL then there is a high rate (odds ratio 559) of postoperative hypocalcemia. These patients should be targeted for aggressive management to minimize hypocalcemia after total thyroidectomy.


Additional risk factors associated with a risk for postoperative hypocalcemia:

(1) age > 50 years

(2) postoperative parathyroid hormone < 10 pg/mL


Reference ranges:

(1) total serum calcium: 8.5 to 10.5 mg/dL

(2) parathyroid hormone: 10 to 65 pg/mL

(3) 25-hydroxyvitamin D3: 6 to 46 ng/mL


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