Hypocalcemia Surveillance, Total Thyroidectomy — Discharge Criteria, Medications, Laboratory Monitoring and Follow-up Recommendations — Clinical Pathway: Inpatient and Outpatient Specialty Care

Thyroidectomy Calcium Management Clinical Pathway — Inpatient and Outpatient Specialty Care

Discharge Criteria, Medications, Laboratory Monitoring and Follow-up Recommendations

Child should meet the following criteria for discharge:

  • Tolerating POs
  • NO calcium gluconate infusion needed within the last 24 hrs
  • Two serum calcium levels > 8.0 mg/dL separated by 6-8 hrs

Prescriptions — Prescribe as Clinically Indicated

  Medication Comments
PO Calcium Carbonate
  • At least 30-day supply with 2 refills
  • Typical maximum amount of calcium per dose
    • 500 mg elemental calcium/dose
  • Generally takes 1-6 mos for parathyroid gland
    to recover
  • Children usually do not require discharge to home on > 3x/day dosing of calcium with meals
PO Calcitriol
  • At least 30-day supply with 2 refills
  • Consider decreasing amount per dose if calcium is > 9 mg/dL and child was on high-dose calcitriol while admitted to inpatient unit

Children Requiring Thyroid Hormone Replacement

Children will be discharged on one of these two thyroid medications, Levothyroxine (L-T4) or Liothyronine (L-T3).
Call endocrine team to determine which formulation is indicated for the child.

Levothyroxine (L-T4) Suggested Dose Selections

Longer-acting; is the most commonly used hormone replacement in children with post-surgical hypothyroidism.
Repeat TFTs will be arranged by the Pediatric Thyroid Center Team.

Age Weight-based Dose Typical Dose
3-6 mos 8-10 mcg/kg 25-50 mcg
6-12 mos 6-8 mcg/kg 25-50 mcg
1-5 yrs 5-6 mcg/kg 25-50 mcg
6-12 yrs 4-5 mcg/kg 50-100 mcg
12-16 yrs 2-3 mcg/kg 75-150 mcg
> 16 yrs 1.6 mcg/kg 100-200 mcg

Liothyronine (L-T3) Suggested Dose Selections

Short-acting; should be used in children with suspected differentiated thyroid cancer who will receive radioactive iodine ablation in several weeks. Consult Thyroid Center to schedule follow-up.

  Dose Frequency
Prepubertal 5-15 mcg/dose Give 2x/day
Pubertal 20-25 mcg/dose Give 2x/day

Laboratory Studies

  • Calcium and phosphorus levels 2-3 days after discharge; PTH is optional — provide 3 sets of lab slips
  • Continue to follow calcium and phosphorous levels weekly until they remain normal while decreasing dose and frequency of calcitriol and calcium
  • Typically, calcitriol is stopped first, followed by calcium
  • Repeat labs sooner based on signs and symptoms of hypo/hypercalcemia
  • Obtain a PTH if the serum calcium is < 8 mg/dl during decreased dose and schedule of calcitriol and calcium

Follow-up Recommendations

Make follow-up appointments for 2-4 wks

Child/parent questions after business hours 215-590-1000, ask to speak to endocrinologist on call.