Yumiao JIN, Yi LIU, Qinyun GU
Endocrinology Research and Practice - 2026;30(3):195-205
Symptomatic hypocalcemia commonly occurs after thyroidectomy, and there is ongoing debate over the relative benefits of different prophylactic calcium supplementing methods. This systematic review and meta-analysis assessed the efficacy of various postoperative calcium regimens in preventing symptomatic hypocalcemia. A search of several databases was conducted up to November 2025 for studies, and the main outcome was the incidence of symptomatic hypocalcemia. Pairwise meta-analyses were conducted using random-effects models. Ten studies involving 1996 patients were included. Compared to control, both oral calcium alone (OR 0.41, 95% CI 0.16-1.07) and oral calcium combined with vitamin D (OR 0.16, 95% CI 0.09-0.32) significantly reduced the risk. The combined regimen was superior to calcium alone (OR 0.35, 95% CI 0.15-0.83). Prophylactic intravenous calcium infusion demonstrated the strongest protective effect (OR 0.23, 95% CI 0.12-0.44). In conclusion, short-term prophylactic calcium supplementation (oral for 1-2 weeks, or intravenous as a single dose or for 3-5 days) effectively reduces the risk of transient symptomatic hypocalcemia after thyroidectomy, with a clear efficacy hierarchy: intravenous calcium is most effective, followed by oral calcium combined with vitamin D (calcitriol or alfacalcidol), then oral calcium alone. Although dosages (elemental calcium 1000-3000 mg/day) and timing of initiation varied across studies, the evidence supports a risk-stratified approach to individualized calcium prophylaxis.
