Among adults undergoing total thyroidectomy, selective calcium and calcitriol supplementation triggered by low postoperative PTH was not superior to routine supplementation for preventing symptomatic or biochemical hypocalcemia.

Question Is selective calcium and calcitriol (C+C) supplementation, guided by postoperative PTH levels, a better strategy than routine supplementation for preventing symptomatic hypocalcemia after total thyroidectomy?

Findings In this randomized clinical trial of 258 patients, the incidence of symptomatic hypocalcemia in the selective C+C supplementation group (7.8%) compared with the routine C+C supplementation group (11.1%) was not signicantly different.

Meaning Selective C+C supplementation based on postoperative PTH levels is not superior to routine supplementation; both are viable options that can be used according to available resources and clinical context.