Taking Calcium After Thyroid Surgery

Hi, this is Dr. Michael Yeh from UCLA Health Endocrine Surgery. I’m here to talk about taking calcium after thyroid surgery. If you’re watching this video, it likely means you’ve had a total thyroidectomy.

One of the known risks of a total thyroidectomy is low blood calcium levels. This happens because the surgery involves manipulating all four parathyroid glands—tiny glands attached to the surface of the thyroid that regulate calcium in the body. There are two on each side, for a total of four. These glands can become temporarily stunned, usually for just a few weeks, following surgery. During this period, we support your calcium levels with supplements.

Calcium Supplementation: Low, Medium, or High

The amount of calcium you’ll need to take after surgery depends on your parathyroid hormone (PTH) level, measured via a blood test about one hour after your surgery.

1. Low Calcium Supplementation

If your PTH levels are good:

• Calcium dosage: 1,000 mg by mouth, twice a day
• Form: Typically regular-strength Tums (calcium carbonate), 500 mg per tablet
• How to take it: 2 tablets in the morning and 2 at night

Most patients on this plan will no longer need calcium supplements by their two-week follow-up.

2. Medium Calcium Supplementation

If your PTH is slightly low:

• Calcium carbonate: 2,000 mg twice a day (4 Tums tablets twice daily)
• Plus: Calcitriol (prescription vitamin D), 0.25 micrograms twice a day

Calcitriol is a small oval pill that helps your body absorb calcium more effectively.

3. High Calcium Supplementation

If your PTH is quite low:

• Calcium carbonate: 2,000 mg three times a day (4 Tums tablets 3 times daily)
• Calcitriol: 0.25 micrograms three times a day

Being on the high-dose regimen means your parathyroid glands are more "asleep" than usual post-surgery, but don’t worry—this is typically temporary.

Weaning Off Calcium

If you're on either the medium or high dose, we will give you clear instructions at your two-week follow-up on how to gradually taper off the calcium and calcitriol over a six-week period as your parathyroid glands recover.

Symptoms of Low Blood Calcium levels

When taking calcium after total thyroidectomy, it’s important to remember that the first sign of low blood calcium levels is a tingling sensation around the mouth, fingers, and toes. Very low calcium levels can cause muscle spasms and cramps. If you experience any of these sensations, please take 4 Tums tablets and call our office for further advice.

Thank you so much for watching. Once again, I’m Dr. Michael Yeh from UCLA Health Endocrine Surgery.

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