Betamethasone to prevent symptomatic hypocalcaemia and other complications after total thyroidectomy. A Case-control study

Purpose: The study aims to determine whether postoperative infusion of betamethasone reduces the risk of symptomatic hypocalcaemia (SHC) and other complications after total thyroidectomy. Methods: We compared a group of patients receiving betamethasone (beta group) postoperatively to a group without any perioperative glucocorticoid infusion (no beta group). Plasma levels of parathyroid hormone, total calcium, and C-reactive protein (CRP) were measured pre- and postoperatively. Complications were recorded within a 30-day follow-up. Postoperative SHC was the primary outcome. Results: In the beta group and the no beta group, 54 patients and 47 patients were included, respectively. In the beta group, the incidence of SHC (4 pts vs. 14 pts in the no beta group; P=0.003) was reduced. In the beta group, serum calcium levels were higher on postoperative day 1 (8.6 mg/dL vs. 8.2 mg/dL in the no beta group; P=0.001) and day 2 (8.7 mg/dL vs. 8.1 mg/dL in the no beta group; P<0.000). In the beta group, serum C-reactive protein levels were lower postoperatively. In a univariate analysis, American Society of Anaesthesiology score > I (odds ratio [OR], 0.19; P=0.002), no betamethasone treatment (OR, 0.19; P=0.006), and parathyroid glands remaining in situ (PGRIS) score <3 (OR, 6.00; P=0.005) were related to postoperative SHC; in a multivariate analysis, betamethasone treatment (OR, 0.09; P=0.007) and PGRIS score <3 (OR, 8.41; P=0.045) were related to postoperative SHC. No difference was observed in postoperative complications. Conclusion: Postoperative use of betamethasone reduces the incidence of SHC after thyroid surgery without affecting other complications.