BACKGROUND
Calcium levels in the body are controlled by parathyroid hormone (PTH), which is produced by the parathyroid glands. There are 4 parathyroid glands and they are located next to the thyroid, usually 2 glands on each side. One of the potential complications of a total thyroidectomy is bruising of the parathyroid glands, causing them to not work well after the operation. This can lead low calcium levels. Postoperative hypocalcemia (or low calcium levels) following thyroidectomy is a common complication that can be seen transiently in up to 30% of cases. This is very rare after a lobectomy, since 2 of the parathyroid glands on the opposite side will not be affected. Fortunately, permanent parathyroid damage and hypocalcemia is very rare. Postoperative hypocalcemia is typically managed with calcium supplementation with or without calcitriol (an active form of vitamin D). Parathyroid function is usually restored in days to weeks after the operation.

The approach to the management of postoperative hypocalcemia varies depending on the surgical team or hospital. Some providers may choose to routinely start calcium supplementation for all patients following thyroid surgery, while others may selectively recommend calcium supplementation based on postoperative parathyroid hormone levels measured on blood work.

This study is a randomized controlled trial comparing the clinical outcomes of routine versus selective calcium supplementation following thyroid surgery.

THE FULL ARTICLE TITLE
Garcia-Lozano C et al. Routine vs selective calcium supplementation after total thyroidectomy: a randomized clinical trial. JAMA Otolaryngol Head Neck Surg 2026;152(4):392–399; doi: 10.1001/jamaoto.2025.5514. PMID: 41712216.

SUMMARY OF THE STUDY
The study looks at patients who underwent a total or completion thyroidectomy (removal of the 2nd lobe after a prior lobectomy). Participants in the study either received calcium carbonate (1200 mg every eight hours) with calcitriol (0.25 mcg every 12 hours) routinely for two weeks after surgery (routine supplementation group with 141 participants) or received the calcium carbonate and calcitriol if the parathyroid hormone level measured four hours after surgery was low (less than 15 pg/ml) (selective supplementation group with 117 participants).

In the selective supplementation group, 50 patients (42.7%) had low postoperative parathyroid hormone levels and were started on calcium supplementation. As a result, postoperative calcium supplementation was required less often in the selective supplementation group compared to the routine supplementation group.

There was no difference in the rate of symptomatic hypocalcemia in the two groups – 7.8% in the selective supplementation group versus 11.1% in the routine supplementation group. Similarly, there was no difference in the occurrence of biochemical hypocalcemia in the two groups – 21.6% in the selective supplementation group versus 17.6% in the routine supplementation group.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
In patients who undergo thyroidectomy, both approaches of routine and selective calcium supplementation for the management of potential hypocalcemia demonstrated similar effectiveness. Individual hospitals may choose a specific strategy based on factors such as the cost of testing and the patient population they serve.

— Poorani Goundan, MD

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