JAMA Otolaryn Head Neck Surg

Selective vs. routine calcium after thyroidectomy: No clear winner

February 23, 2026

In this multicenter randomized trial (NCT05252884) of 258 adults undergoing total thyroidectomy, investigators compared selective calcium + calcitriol supplementation—initiated only when 4‑hour postoperative parathyroid hormone (PTH) levels were <15 pg/mL—with routine 15‑day prophylaxis for all patients. Rates of symptomatic hypocalcemia at 15 days were low and not significantly different (7.8% with selective vs. 11.1% with routine supplementation; odds ratio [OR], 0.68; 95% confidence interval [CI], 0.29–1.57; P = 0.36). Biochemical hypocalcemia likewise showed no meaningful difference (21.6% vs. 17.6%; OR, 1.29; 95% CI, 0.57–2.93; P =0 .53). Adverse events and complications were comparable, while the selective strategy required less overall supplementation.

Clinical takeaway: Either strategy is reasonable; consider a selective approach to avoid overtreatment when rapid PTH testing is available.

Source:

Garcia-Lozano C, et al. (2026, February 19). JAMA Otolaryngol Head Neck Surg. Routine vs Selective Calcium Supplementation After Total Thyroidectomy: A Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/41712216/