POSTPARATHYROIDECTOMY CALCIUM

What is the best way to manage calcium supplementation (dosage, duration, etc.) in a 15-year-old female who underwent parathyroidectomy for parathyroid adenoma?
—Arun Kannan, MD, Cochin, Kerala, India

According to Davies et al, up to “70%” of patients may have transient hypoparathyroidism immediately post parathyroidectomy (Clin Endocrinol. 2002;57:145-155). Calcium generally reaches its lowest level at 24-36 hours postoperatively. This transient and mild hypocalcemia does not usually require treatment, particularly in the absence of symptoms. Calcium and parathyroid hormone levels generally normalize within weeks, and the recovery of bone mineral density begins quickly. Symptomatic hypocalcemia is relatively rare and may require treatment with both vitamin D and calcium supplementation (1-2 g calcium daily) in the short term. Davies et al noted that prolonged or permanent hypoparathyroidism is thought to be unusual (<2% of cases) with modern surgical techniques. Hence, long-term calcium supplementation may not be necessary in your patient.
—Christopher Ruser, MD (115-22)

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