Hypocalcemia Surveillance, Total Thyroidectomy — Preoperative Care — Clinical Pathway: Inpatient and Outpatient Specialty Care

Thyroidectomy Calcium Management Clinical Pathway — Inpatient and Outpatient Specialty Care

Preoperative Care

Preoperative planning for children undergoing thyroidectomy is crucial. Ensuring normal thyroid function prior to the procedure reduces risk of complications associated with profound hypothyroidism and hyperthyroidism. Additionally, children should have their vitamin D status optimized to reduce the risk of hypocalcemia following surgery.

Thyroid Function
  • All children
    • Normalize T3 and T4 within 2-4 wks of surgery
  • Children with Graves' disease only
    • Start potassium iodide – 1 g/mL oral solution (SSKI)
      • Use individual clinician decision-making for necessity, dose, length of treatment
      • Recommended dosage
        • Give 3-5 drops (150 to 250 mg/dose; 1 g/ml potassium iodide – SSKI)
          3 times per day for 10-14 days before surgery
Vitamin D Give single dose of oral cholecalciferol 50,000 international units 7-10 days before surgery
Home Medications
  • Discontinue on admission
    • Propranolol
    • Atenolol
    • Potassium iodide drops
    • Methimazole
ioPTH Notify lab to anticipate need for ioPTH