How is hypoparathyroidism managed following thyroid surgery?

Updated: Jan 25, 2018
  • Author: Pramod K Sharma, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

Patients who have asymptomatic hypocalcemia in the early postoperative period should not be treated with supplemental calcium. The hypocalcemic state may stimulate the stunned parathyroid glands to produce PTH.

Patients who have symptomatic hypocalcemia in the early postoperative period or whose calcium levels continue to fall rapidly require treatment. In symptomatic patients, replace calcium with intravenous calcium gluconate. Ten milliliters of 10% solution (1 g) may be administered over 10 minutes. A calcium infusion may be started at a rate of 1-2 mg/kg/h if symptoms do not resolve. Titrate the infusion to the patient's symptoms and calcium levels. Typically, patients that begin to have symptoms can be started on oral calcium. One to two grams of elemental oral calcium should be supplied each day. Calcium carbonate 1250 mg provides 500 mg of elemental calcium; therefore, the patient should take 2500-5000 mg/day. The patient needs concomitant replacement of vitamin D with calcitriol (Rocaltrol) 0.25-1 mcg/d. The calcium supplementation should be divided 4 - 5 times per day rather than in a single dose to maximize absorption by the GI tract.

Endocrinology consultation may provide assistance in monitoring of calcium levels and the medical management of the sequelae of hypoparathyroidism. In 1-2 months, an attempt to wean the patient off oral calcium may be made to reveal if the hypoparathyroidism is temporary. Dependence on calcium supplementation for longer than 6 months usually indicates permanent hypoparathyroidism.


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