Oral calcium supplements to enhance early hospital discharge after bilateral surgical treatment of the thyroid gland or exploration of the parathyroid glands.

Abstract

One hundred and seventy consecutive patients undergoing parathyroid gland exploration and bilateral thyroidectomy received, postoperatively, routine oral calcium supplementation, close monitoring of total serum calcium, and addition of vitamin D for specific criteria, all to accomplish a postoperative course free of symptomatic hypocalcemia and early discharge from the hospital. Twelve of these patients underwent simultaneous thyroid gland and parathyroid gland operation. Parathyroid gland manipulation during these operations was aggressive. Of the 58 patients undergoing parathyroid exploration, two required hospitalization for more than three days to treat hypocalcemia. No patients required intravenous calcium and 17 of the last 24 having total serum calcium greater than or equal to 9.0 milligrams per deciliter at 36 hours were discharged uneventfully on the morning of the second postoperative day. Of the 124 patients undergoing bilateral thyroidectomy, four required hospitalization in excess of three days for hypocalcemia, one required intravenous calcium and one still requires daily vitamin D after a year. Eighty-five of the last 96 patients having a total serum calcium greater than or equal to 8.5 milligrams per deciliter at 36 hours were discharged on the morning of the second postoperative day, without subsequent hypocalcemic events. These data suggest that a program of calcium supplementation combined with enthusiastic outpatient support can be the future basis for same day or one day admissions after parathyroid gland or extensive thyroid gland operations.