From the Research
Hypocalcemia after mastectomy is primarily caused by accidental removal of or damage to the parathyroid glands during surgery, especially when the procedure involves extensive lymph node dissection, as supported by the most recent and highest quality study 1.
Causes of Hypocalcemia
- Accidental removal of or damage to the parathyroid glands during surgery
- Extensive lymph node dissection
- Pre-existing vitamin D deficiency
- Chronic kidney disease
- Malabsorption disorders
Symptoms of Hypocalcemia
- Numbness and tingling in the extremities
- Muscle cramps
- Tetany
- Seizures or cardiac arrhythmias in severe cases
Treatment of Hypocalcemia
- Calcium supplementation with oral calcium carbonate 1000-2000 mg daily divided into multiple doses
- Vitamin D supplementation with calcitriol 0.25-0.5 mcg daily to enhance calcium absorption
- Intravenous calcium gluconate for severe symptomatic hypocalcemia
- Regular monitoring of serum calcium levels during recovery
The study by 1 found that perioperative oral calcium and vitamin D supplementation significantly decreased the risks of symptomatic and biochemical hypocalcemia compared to postoperative oral calcium and vitamin D supplementation. Another study by 2 also found that pre-operative treatment with calcium, vitamin D or both calcium and vitamin D reduces the risk of post-operative hypocalcemia. However, the most recent and highest quality study 1 provides the strongest evidence for the causes and treatment of hypocalcemia after mastectomy.
It is essential to note that while the provided studies focus on thyroidectomy, the principles of hypocalcemia management can be applied to mastectomy patients as well, given the similar risk of parathyroid gland damage during surgery. Therefore, perioperative calcium and vitamin D supplementation is recommended to prevent hypocalcemia after mastectomy, based on the strongest and most recent evidence 1.