Endocrine Abstracts

Background: Transient hypocalcaemia post parathyroid or thyroidectomy is common. Locally, post operative follow up was Ad-hoc with weekly visits where one of the Endocrine team would reduce Adcal D3© or 1α-Hydroxycholecalciferol doses to maintain eucalcaemia. This was frustrating for staff and patients who spent weeks and sometimes months having weekly blood tests. In an effort to improve the experience we piloted a pathway based on fixed dose replacement and day 1 parathyroid hormone (PTH) and corrected calcium results.

Method: Day 1: PTH and corrected Calcium was checked and everyone was discharged on 1 × Adcal D3© bd and 1α-Hydroxycholecalciferol 0.25 mcg tds. Day 7: review day 1 results. Reference range results; thyroidectomy patients stop supplements and parathyroidectomy patients reduced to 1 × Adcal D3© bd and 1α-Hydroxycholecalciferol 0.25 mcg bd. Low PTH or corrected calcium; thyroidectomy patients reduced to 1 × Adcal D3© bd and 1α-Hydroxycholecalciferol 0.25 mcg bd while Parathyroidectomy stayed on day 1 dose. Post operative week 8 and month 6: Check PTH and calcium and if within reference range stop treatment and if below reference range continue.

Results: Ten patients (9 thyroidectomy and 1 parathyroidectomy) were seen. Five thyroidectomy patients had normal Day 1 results and stopped treatment after 7 days. The remaining four had reference range results at week 8 and stopped treatment then. The Parathyroidectomy patient reduced their dose week one, had reference range results week 8 and stopped treatment. No patient has developed hypocalcaemia after stopping treatment.

Conclusion: The pathway is simple to follow. All patients stopped supplements by week 8 and visits reduced from over eight to just two. Our next step is to use same day PTH results. This will remove the need for day seven review and further streamline the process and further reduce the burden to patents and staff.