Calcium, vitamin D or recombinant parathyroid hormone for managing post-thyroidectomy hypoparathyroidism

Review question

What are the effects of calcium, vitamin D and parathyroid hormone in the management of low parathyroid hormone following thyroid surgery?

Background

The parathyroid glands are four small glands attached to the thyroid gland. They produce parathyroid hormone which regulates blood calcium levels. These glands may be accidentally damaged during surgery, for example after removal of the thyroid gland. The consequence of this is low blood calcium levels. The damage to the parathyroid glands may be temporary or long term. The use of calcium and vitamin D supplements to normalise the blood calcium level is the mainstay of treatment in these people but the precise nature, dose and duration of these treatments vary across centres. Recent studies suggest the use of laboratory-engineered (recombinant) parathyroid hormone as a treatment option. Current guidelines on the management of post-thyroidectomy hypoparathyroidism are based on low-quality evidence. We aimed to review high-quality research evaluating the use of calcium, vitamin D and parathyroid hormone in this condition. In addition, we aimed to highlight gaps in the current literature and to stimulate further clinical studies in this field.

Study characteristics

We found no relevant randomised controlled trials (clinical trials where people are randomly allocated to one of two or more treatment groups) or controlled clinical trials that evaluated the use of calcium, vitamin D supplements and parathyroid hormone in this condition.

This evidence is up to date as of 17 December 2018.

Key results

Lack of high-quality evidence on the use of calcium, vitamin D and parathyroid hormone in the management of low parathyroid hormone after thyroid surgery.

Certainty of the evidence

We could not critically appraise the certainty of the evidence because we did not identify studies matching our inclusion criteria.

Authors' conclusions: 

This systematic review highlights a gap in the current literature and the lack of high-quality evidence in the management of post-thyroidectomy temporary and long-term hypoparathyroidism. Further research focusing on clinically relevant outcomes is needed to examine the effects of current treatments in the management of temporary and long-term post-thyroidectomy hypocalcaemia.

Read the full abstract...
Background: 

Post-surgical hypoparathyroidism is a common complication after thyroid surgery. The incidence is likely to increase given the rising trend in the annual number of thyroid operations being performed. Measures to prevent post-thyroidectomy hypoparathyroidism including different surgical techniques and prophylactic calcium and vitamin D supplements have been extensively studied. The management of post-thyroidectomy hypoparathyroidism however has not been extensively evaluated. Routine use of calcium and vitamin D supplements in the postoperative period may reduce the risk of symptoms, temporary hypocalcaemia and hospital stay. However, this may lead to overtreatment and has no effect on long-term hypoparathyroidism. Current recommendations on the management of post-thyroidectomy hypoparathyroidism is based on low-quality evidence. Existing guidelines do not often distinguish between surgical and non-surgical hypoparathyroidism, and transient and long-term disease.

The aim of this systematic review was to summarise evidence on the use of calcium, vitamin D and recombinant parathyroid hormone in the management of post-thyroidectomy hypoparathyroidism. In addition, we aimed to highlight deficiencies in the current literature and stimulate further work in this field.

Objectives: 

The objective of this systematic review was to assess the effects of calcium, vitamin D and recombinant parathyroid hormone in managing post-thyroidectomy hypoparathyroidism.

Search strategy: 

We searched CENTRAL, MEDLINE, PubMed, Embase as well as ICTRP Search Portal and ClinicalTrials.gov. The date of the last search for all databases was 17 December 2018 (except Embase, which was last searched on 21 December 2017). No language restrictions were applied.

Selection criteria: 

We planned to include randomised control trials (RCTs) or controlled clinical trials (CCTs) examining the effects of calcium, vitamin D or recombinant parathyroid hormone in people with temporary and long-term post-thyroidectomy hypoparathyroidism.

Data collection and analysis: 

Two review authors independently screened titles, abstracts and full texts for relevance.

Main results: 

Database searches yielded a total of 1751 records. We retrieved potentially relevant full texts and excluded articles on the following basis: not a RCT or CCT; intervention, comparator or both did not match prespecified criteria; non-surgical causes of hypoparathyroidism, and studies on prevention. None of the articles was eligible for inclusion in the systematic review.

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