Abstract:
Objective To evaluate the efficacy of oral Calcium and Vitamin D supplements in prevention of hypocalcemia after total thyroidectomy through a meta analysis.
Methods All randomized controlled trials (RCTs) of oral Calcium and Vitamin D for the prevention of hypocalcemia after total thyroidectomy were collected. The quality of included RCTs was assessed and relevant data were selected according to the standard of Cochrane systematic review by two reviewers. Statistical software RevMan 5.2 was used for meta analysis.
Results Four randomized controlled trials with 459 cases were included. The results showed that early and combined administration of both oral Calcium and Vitamin D can improve the serum Calcium levels higher than those of patients who received only oral Calcium or no supplements. The incidence of hypocalcemia was significantly lower after combined oral Calcium and Vitamin D than no supplements RR=0.32,95%CI(0.17,0.59),
P=0.000 3. There was no significant difference in PTH levels among the three groups. Compared with no supplements after total thyroidectomy, combined with oral Calcium and Vitamin D can prevent symptomatic hypocalcemia RR=0.23, 95%CI(0.09,0.56),
P=0.001. The patients who need intravenous Calcium after combined oral Calcium and Vitamin D RR=0.15, 95%CI(0.03,0.80),
P=0.03 or only oral Calcium RR=0.24,95%CI(0.06,0.91),
P=0.04 were significantly fewer than those with no supplements total thyroidectomy.
Conclusion Current evidence indicates that early and combined administration of both oral Calcium and Vitamin D can improve the serum Calcium and prevent symptomatic hypocalcemia more effectively than merely oral Calcium or no supplements. Because of limited studies, more high quality randomized controlled trials with larger samples are required to get further confirmation.