Correspondence (letter to the editor): Importance of Postoperative Hypocalcemia

In his review the author describes the hormone replacement therapy after thyroid surgery, as well as the therapeutic options in hypocalcemia following thyroid or parathyroid surgery. Important issues in this context are not mentioned. The different medicinal options are described in detail, but their practical implementation and the consequences for the affected patients are not explained. Whereas permanent hypocalcemia is rare, even transient hypothyroidism occuring in 10–25% is a serious complication. Further to the demanded intraoperative exposure of all 4 parathyroid glands, also their immediate autotransplantation in the strap muscles in case of visible or expected ischemia to prevent permanent hypoparathyroidism has to be mentioned. Clinically manifest hypocalcemia puts a severe strain on patients and may affect their quality of life substantially. For this reason it is important to explain to patients with postoperative hypocalcemia—even if this is considered transient—in detail the symptoms and prognosis and provide them and the general practitioners practical guidelines. In our hospital, we determine serum calcium and parathyroid hormone before and after surgery in all thyroid and parathyroid patients. In case of postoperative hypoparathyroidism (<15 pg/mL) we substitute even in patients without symptoms 3×1,000 mg calcium/d plus 2×0.5 µg 1.25-dihydroxy-cholecalciferol/d for at least 2–3 weeks, since these patients are usually discharged after 2 days. The substitution treatment is eventually completed after examinations by the general practitioner or endocrinologist. In case of reoperations of the parathyroid glands or multiple gland disease, the facility of cryopreservation of parathyroid tissue for possible later reimplantation should be available.