List of indications in which it is important to consider intravenous calcitriol administration [18, 24–27]
Dysphagia
Malabsorption
Hyperparathyroidism secondary to advanced chronic kidney disease
Neurological disorders: stroke, multiple sclerosis, Parkinson's disease or amyotrophic lateral sclerosis, etc.
Gastrointestinal disorders: celiac disease, Crohn’s disease, short bowel syndrome, ulcerative colitis, bariatric surgery
Severe secondary hyperparathyroidism
Muscular diseases: myasthenia gravis and muscular dystrophies
Bile duct pathology
Refractory to oral medical treatment
Cancer: tumours in the mouth, pharynx or larynx
Pancreatic pathology, such as chronic pancreatitis
Patients who develop hypercalcaemia with oral calcitriol treatment
Oesophageal pathology: oesophageal stricture, achalasia, oesophagitis, oesophageal diverticula, oesophageal cancer
Drugs: anticonvulsants, some HIV drugs, and certain cholesterol-lowering drugs (such as bile acid sequestrants)
To avoid surgical parathyroidectomy in some cases
Declarations
Author contributions
IJH, LGF, and MPN: Conceptualization, Investigation, Writing—original draft, Writing—review & editing, Validation. All authors read and approved the submitted version.
Conflicts of interest
All authors declare that they have no conflicts of interest.
Ethical approval
The study “Intravenous calcitriol: a critical intervention for severe postoperative hypoparathyroidism when oral administration is not feasible”, carried out by Dr. Ignacio Jiménez Hernando from the Department of Endocrinology and Nutrition Service of the Hospital General Universitario Gregorio Marañón has been reviewed by the Ethics Committee of the Hospital General Universitario Gregorio Marañón (CEIm HGUGM), and CEIm HGUGM found no ethical impediment to the study’s publication and dissemination, as stated in Minute 05/2025, of March 3.
Consent to participate
Informed consent to participate in the study was obtained from the participants.
Consent to publication
Informed consent to publication was obtained from the relevant participants.
Availability of data and materials
The datasets that support the findings of this study are available from the corresponding author upon reasonable request.
Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.
References
Balasubramanian SP. Iatrogenic/post-surgical hypoparathyroidism: where do we go from here?Endocrine. 2014;47:357–9. [DOI] [PubMed]
Costanzo M, Marziani A, Condorelli F, Migliore M, Cannizzaro MA. Post-thyroidectomy hypocalcemic syndrome: predictive value of early PTH. Preliminary results.Ann Ital Chir. 2010;81:301–5. [PubMed]
Gervasi R, Orlando G, Lerose MA, Amato B, Docimo G, Zeppa P, et al. Thyroid surgery in geriatric patients: a literature review.BMC Surg. 2012;12:S16. [DOI] [PubMed] [PMC]
Velicescu C, Bilha SC, Teleman A, Vitelariu A, Teodoriu L, Florescu A, et al. Incidence of transient and chronic hypoparathyroidism after total thyroidectomy – the experience of a tertiary center.Arch Clin Cases. 2024;11:93–7. [DOI] [PubMed] [PMC]
Cocchiara G, Cajozzo M, Fazzotta S, Palumbo VD, Geraci G, Maione C, et al. Risk factors’ analysis of transient and permanent hypoparathyroidism after thyroidectomy.Clin Ter. 2017;168:e271–7. Italian. [DOI] [PubMed]
Pepe J, Colangelo L, Biamonte F, Sonato C, Danese VC, Cecchetti V, et al. Diagnosis and management of hypocalcemia.Endocrine. 2020;69:485–95. [DOI] [PubMed]
Orloff LA, Wiseman SM, Bernet VJ, 3rd TJF, Shaha AR, Shindo ML, et al. American Thyroid Association Statement on Postoperative Hypoparathyroidism: Diagnosis, Prevention, and Management in Adults.Thyroid. 2018;28:830–41. [DOI] [PubMed]
Kumar R, Drinnan M, Robinson M, Meikle D, Stafford F, Welch A, et al. Thyroid gland invasion in total laryngectomy and total laryngopharyngectomy: a systematic review and meta-analysis of the English literature.Clin Otolaryngol. 2013;38:372–8. [DOI] [PubMed]
Pasha HA, Wasif M, Ikram M, Hammad M, Ghaloo SK, Rashid Z. Frequency of Thyroid Gland Invasion by Laryngeal Squamous Cell Carcinoma: The Role of Subglottic Extension.Int Arch Otorhinolaryngol. 2022;26:e574–8. [DOI] [PubMed] [PMC]
Marcocci C, Cianferotti L. The parathyroids. In: Miccoli P, Terris DJ, Minuto MN, Seybt MW, editors. Thyroid surgery: preventing and managing complications. John Wiley and Sons; 2012. pp. 227–36. [DOI]
Stack BC Jr, Bimston DN, Bodenner DL, Brett EM, Dralle H, Orloff LA, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: Postoperative Hypoparathyroidism - Definitions and Management.Endocr Pract. 2015;21:674–85.Erratum in: Endocr Pract. 2015;21:1187. [DOI] [PubMed]
Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia.Br J Surg. 2014;101:307–20. [DOI] [PubMed]
Cho JN, Park WS, Min SY. Predictors and risk factors of hypoparathyroidism after total thyroidectomy.Int J Surg. 2016;34:47–52. [DOI] [PubMed]
Cianferotti L, Marcucci G, Brandi ML. Causes and pathophysiology of hypoparathyroidism.Best Pract Res Clin Endocrinol Metab. 2018;32:909–25. [DOI] [PubMed]
Negm H, Mosleh M, Fathy H, Awad A. Thyroid and parathyroid dysfunction after total laryngectomy in patients with laryngeal carcinoma.Eur Arch Otorhinolaryngol. 2016;273:3237–41. [DOI] [PubMed]
Edafe O, Sandler LM, Beasley N, Balasubramanian SP. Systematic review of incidence, risk factors, prevention and treatment of post-laryngectomy hypoparathyroidism.Eur Arch Otorhinolaryngol. 2021;278:1337–44. [DOI] [PubMed] [PMC]
Edafe O, Tan ET, Jackson R, Sionis S, Balasubramanian SP, Beasley N. Evaluation of hypoparathyroidism following laryngectomy.Ann R Coll Surg Engl. 2023;105:62–7. [DOI] [PubMed] [PMC]
Lips P. Vitamin D physiology.Prog Biophys Mol Biol. 2006;92:4–8. [DOI] [PubMed]
Wimalawansa SJ. Physiology of Vitamin D—Focusing on Disease Prevention.Nutrients. 2024;16:1666. [DOI] [PubMed] [PMC]
Edafe O, Mech CE, Balasubramanian SP. Calcium, vitamin D or recombinant parathyroid hormone for managing post-thyroidectomy hypoparathyroidism.Cochrane Database Syst Rev. 2019;5:CD012845. [DOI] [PubMed] [PMC]
Bilezikian JP, Clarke BL, Mannstadt M, Rothman J, Vokes T, Lee H, et al. Safety and Efficacy of Recombinant Human Parathyroid Hormone in Adults With Hypoparathyroidism Randomly Assigned to Receive Fixed 25-μg or 50-μg Daily Doses.Clin Ther. 2017;39:2096–102. [DOI] [PubMed]
Yeh C, Wu J, Su L, Yang P, Lee P, Chen K, et al. Intravenous calcitriol administration regulates the renin-angiotensin system and attenuates acute lung injury in obese mice complicated with polymicrobial sepsis.Biomed Pharmacother. 2021;141:111856. [DOI] [PubMed]
Fernandez E, Llach F. Guidelines for dosing of intravenous calcitriol in dialysis patients with hyperparathyroidism.Nephrol Dial Transplant. 1996;11 Suppl 3:96–101. [DOI] [PubMed]
McCarty EB, Chao TN. Dysphagia and Swallowing Disorders.Med Clin North Am. 2021;105:939–54. [DOI] [PubMed]
Pludowski P, Takacs I, Boyanov M, Belaya Z, Diaconu CC, Mokhort T, et al. Clinical Practice in the Prevention, Diagnosis and Treatment of Vitamin D Deficiency: A Central and Eastern European Expert Consensus Statement.Nutrients. 2022;14:1483. [DOI] [PubMed] [PMC]
Almirall J, Torregrosa V, Arrizabalaga P, Cases A, Oliva J. [Intravenous calcitriol in the treatment of the refractory secondary hyperparathyroidism of terminal chronic kidney failure].Med Clin (Barc). 1994;102:325–8. Spanish. [PubMed]
Dressler R, Laut J, Lynn RI, Ginsberg N. Long-term high dose intravenous calcitriol therapy in end-stage renal disease patients with severe secondary hyperparathyroidism.Clin Nephrol. 1995;43:324–31. [PubMed]
Yeh C, Wu J, Yang P, Lee P, Chen K, Huang C, et al. Intravenous calcitriol administration modulates mesenteric lymph node CD4+ T-cell polarization and attenuates intestinal inflammation in obese mice complicated with polymicrobial sepsis.JPEN J Parenter Enteral Nutr. 2022;46:1371–83. [DOI] [PubMed]
Jones AS, Warren AM, Bach LA, Sztal-Mazer S. The challenges of post-bariatric surgery hypocalcaemia in pre-existing hypoparathyroidism.Endocrinol Diabetes Metab Case Rep. 2020;2020:20–0103. [DOI] [PubMed] [PMC]
