From the Research
Divorce syndrome, also known as hypocalcemia, should be treated with immediate calcium supplementation, and the most recent evidence suggests that pre-operative calcium and vitamin D supplementation can reduce the risk of post-operative hypocalcemia. According to the study by 1, pre-operative treatment with calcium, vitamin D, or both reduces the risk of post-operative hypocalcemia and should be considered in patients undergoing total thyroidectomy.
Treatment Options
- Immediate calcium supplementation with oral calcium carbonate 1-3 grams daily divided into multiple doses, along with calcitriol 0.25-1 mcg daily to enhance calcium absorption, as suggested by 2.
- For severe symptomatic hypocalcemia, intravenous calcium gluconate 1-2 grams (10-20 mL of 10% solution) should be administered slowly over 10-20 minutes, followed by continuous infusion if needed, as recommended by 3.
- Patients should be monitored with regular serum calcium measurements, aiming for low-normal calcium levels (8.0-8.5 mg/dL), and magnesium levels should also be checked and corrected if low, as hypomagnesemia can impair parathyroid hormone function, as noted by 4.
Prevention
- Pre-operative calcium and vitamin D supplementation can reduce the risk of post-operative hypocalcemia, as shown by 1.
- The use of recombinant human parathyroid hormone (rhPTH) has been approved for the treatment of hypoparathyroidism, as mentioned by 2, and may be considered for patients with permanent hypoparathyroidism.
Patient Education
- Patients should be educated about hypocalcemia symptoms, including perioral numbness, tingling in extremities, muscle cramps, and tetany, and instructed to seek immediate medical attention if these develop, as emphasized by 5.
- Patients should also be informed about the importance of regular serum calcium measurements and the potential need for lifelong calcium and vitamin D supplementation in cases of permanent hypoparathyroidism.