# Low Calcium After Thyroidectomy



## lavender (Jul 13, 2010)

Hi, I have commented on several people's posts, but this is my first time starting a thread. I hope someone can help me or at least sympethize! 
I had a TT two weeks ago, and I am dealing with extremely low calcium levels post surgery. I ended up back in the ER less then 24 hours after discharge because my levels had plummeted, my lips were tingly, I could not feel my hands and had lost all dexterity in them, I was not interested in eating, had a really bad headache, was unable to get up from sleep, had hallucinations, and was really really really grumpy! I initially thought some of this was the result of dealing with anesthesia, trauma of surgery, and pain meds (I required a really strong narcotic due to allergies). But realized the next day that something was off, and called the on-call surgeon, who sent me back to the hospital, taking 4 tums on the way! 
They put in another IV, took my blood calcium levels, hooked me up to all the heart monitors, and gave me IV calcium. Well, I immediately felt better. Headache started to go away, I got up, walked around the hospital, ate, and went home. My pain levels even went down. I was afraid to take too much after the IV dose and waited to take any more calcium until the next day which was a big mistake becuase by then I was feeling lousey again! Not as bad as the day before, but pretty bad.
It took me about a week to balance my calcium levels after surgery. Once I did, I felt amazing! I am taking 16 calctrate pills a day and getting mega-high doses per doctor's orders. Doc told me calctrate is most easily absorbed, and includes vitamin D. I take 3 that are Calcium+D3 plus one that is Calcium+D3+Magnesium 4x a day, plus suppliemntal doses of 1-2 when I feel my levels dropping. I can tell when I am not taking enough. 
They checked my blood levels on Tuesday and called to confirm I was taking the right dose. (RN told me the numbers, but I can't remember them, just that I was on the low end of normal). Checking again in two weeks.
I was just wondering if anyone else out there has had to deal with this. I knew that hypocalcemia was a risk of surgery due to parathyroid involvement, but had no idea how it would affect me. I am hoping it is temporary, but know this can be a life-ling condition.
This is nothing compared to the hyper symptoms I was having prior to surgery, but it's just really annoying to be taking 16 huge calcium suppliments a day. They are too big to swallow, and I am having to crush them up in juice, which is really gross. I have been trying to wake myself up in the middle of the night to take a does to keep my levels up, which is hard and makes me not want to get up in the AM. Also, I am spacing it 3 hours away from the levothyroixine to avoid an interaction.


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## Andros (Aug 26, 2009)

lavender said:


> Hi, I have commented on several people's posts, but this is my first time starting a thread. I hope someone can help me or at least sympethize!
> I had a TT two weeks ago, and I am dealing with extremely low calcium levels post surgery. I ended up back in the ER less then 24 hours after discharge because my levels had plummeted, my lips were tingly, I could not feel my hands and had lost all dexterity in them, I was not interested in eating, had a really bad headache, was unable to get up from sleep, had hallucinations, and was really really really grumpy! I initially thought some of this was the result of dealing with anesthesia, trauma of surgery, and pain meds (I required a really strong narcotic due to allergies). But realized the next day that something was off, and called the on-call surgeon, who sent me back to the hospital, taking 4 tums on the way!
> They put in another IV, took my blood calcium levels, hooked me up to all the heart monitors, and gave me IV calcium. Well, I immediately felt better. Headache started to go away, I got up, walked around the hospital, ate, and went home. My pain levels even went down. I was afraid to take too much after the IV dose and waited to take any more calcium until the next day which was a big mistake becuase by then I was feeling lousey again! Not as bad as the day before, but pretty bad.
> It took me about a week to balance my calcium levels after surgery. Once I did, I felt amazing! I am taking 16 calctrate pills a day and getting mega-high doses per doctor's orders. Doc told me calctrate is most easily absorbed, and includes vitamin D. I take 3 that are Calcium+D3 plus one that is Calcium+D3+Magnesium 4x a day, plus suppliemntal doses of 1-2 when I feel my levels dropping. I can tell when I am not taking enough.
> ...


Did you talk to your surgeon? Maybe he or she had to remove a couple of the parathyroids?

I have never had this happen but have read a lot about it and from what I can tell, this is most likely temporary provided you do have some parathyroids. I believe there are 4. I have also read that sometimes if they can't gain access, the surgeon will remove the parathyroids and tranplant one or two in the shoulder or clavical area. How about that?

Your supplements are not chewable, I take it? If you are having trouble and who wouldn't after a TT, I would call the doctor and ask for something that is easier for you to swallow. Something chewable or a liquid.

I have been reading your postings. They are very very nice and also very helpful. I am glad perhaps we can help you a bit for a change.


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## lavender (Jul 13, 2010)

Thanks Andros,
I have spoken with my surgeon since surgery, but did not ask about the parathyroids. I was still pretty out of it on the day of the appointment due to calcium issue. I will do this the next time I see him, which is in about 3 weeks.

Couldn't find a chewable supplement in the brand that was suggested. Other brands do not have the same type of calcium, and from what I have read, what I am taking is most easily absorbed. I asked the surgeon about a liquid when I saw him, and he said he did not know of anything that was as good as what I am taking now. I do not want to risk taking something that is not as effective because of how bad I feel when my calcium goes low and then it takes about 2 days for me to get it back up to feeling better. I see my endocrinologist this week, perhaps he will have some suggestions since I expect he will be treating me long term once the surgeon releases me.

Posting has really been helpful to me. I am still digesting what has happened to me over these past few months, and this has been a way for me to get it all out. I read this forum a lot when I was hyper, and got a lot of good info that helped me make my decision, but until I had my surgery, I could not think clearly enough to post anything.


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## Andros (Aug 26, 2009)

lavender said:


> Thanks Andros,
> I have spoken with my surgeon since surgery, but did not ask about the parathyroids. I was still pretty out of it on the day of the appointment due to calcium issue. I will do this the next time I see him, which is in about 3 weeks.
> 
> Couldn't find a chewable supplement in the brand that was suggested. Other brands do not have the same type of calcium, and from what I have read, what I am taking is most easily absorbed. I asked the surgeon about a liquid when I saw him, and he said he did not know of anything that was as good as what I am taking now. I do not want to risk taking something that is not as effective because of how bad I feel when my calcium goes low and then it takes about 2 days for me to get it back up to feeling better. I see my endocrinologist this week, perhaps he will have some suggestions since I expect he will be treating me long term once the surgeon releases me.
> ...


I do know "not thinking clearly!" You will find that helping others not only helps you gain more and more knowledge but it also keeps your cup full! I just love it and feel like I "am passing it forward!"

Please let us all know what your surgeon has to say about the parathyroids and what about the pathology on your thyroid gland? Did that all come back good?

Do you have a mortar and a pestle? If you do, you can crush those suckers and mix in some flavored yogurt or something; could you?


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## refinnej (Jul 31, 2010)

Did you have your calcium levels checks after surgery? I know they tested mine 3 times and I was told they were normal. I'm wondering if that's why I am feeling so loopy and not the Cytomel.


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## Andros (Aug 26, 2009)

refinnej said:


> Did you have your calcium levels checks after surgery? I know they tested mine 3 times and I was told they were normal. I'm wondering if that's why I am feeling so loopy and not the Cytomel.


It could be both things.


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## lavender (Jul 13, 2010)

Surgeon said pathology report Looked good-no cancer. I asked him if it was enlarged, and he said only a little-he is really a man of few words! I honestly had no reason to expect cancer, no nodules or goiter, but it was relief to know for sure. 
I just had a thyroid that went super-hyper from Graves this spring. My T3 was over 4x the normal level when I was hospitalized in May, TSI and thyroid uptake and scan confirmed Graves. I suspect my thyroid has been wreaking havoc under the radar for years, but could never convince my PCP until this spring when I went to see her with what I thought were a bunch of unrelated symptoms, asked her to check my thyroid on a whim, and my results came back hyper. Since the ATDs weren't helping me feel better after 3 months, I just wanted my thyroid out so that I could return to my life, and that is what it has let me do. I am so relieved that it is out, and hope that since it can no longer wreak havoc on the rest of my body, I can reach a homeostasis that has not been possible for years. 
I do not have a mortar and pestle, they are on my list of kitchen wants, but I did buy good pill crusher that could handle the giant calcium. I tried putting the calcium in apple sauce for variation yesterday, and that helped. This morning I was too lazy to crush and tried swallowing a slightly different supplement, and was able to with a ton of water and patience. I just had to take an extra one to equal the dose I was getting with the mega pills. Since I ran out of the mega-sized supplements my doc recommended, I am off to the drug store now to buy more calcium, and will see if there is a comparable equivalent in a smaller pill size, even if I have to double up. I usually have no trouble swallowing pills, but I am trying to be extra gentle on my throat as I heal (it;s still a little sore), and I am afraid I would do damage with those mega pills!

refinnej:I was given tums with OJ in the hospital post surgery, and they drew calcium levels like every 6 hours while I was there and reported no problems to me. They did not even suggest I take tums at home, I just did on instinct that I did not want to stop anything the hospital was doing too quickly. The night I got home, I was in really rough shape, having hallucinations and unable to get myself out of bed. I thought it was normal post-surgery and pain med side effects (I am allergic to a lot of narcotics, and since my pain could only be controlled by an IV med at the hospital, I had to be sent home on a really powerful drug).
It wasn't until I got up the next day that I realized I couldn't feel my hands or really do anything useful with them and that my lips were tingly. I had remembered that was a sign they warned me about, and called the on call surgeon, who told me to take tums on the way to the ER where they gave me the IV dose and a lot of what I thought was normal post surgery went away. Looking back, I think what I went through that first night had a lot to do with calcium, and was not normal. I have since read that low calcium sx can show up like 72 hours after surgery to show up. The on call doc was really concerned that my surgeon had not ordered me to take calcium at home and had not recommended anything other than tums. He said he has all his thyroid patients take calcitrol after surgery preventatively due to risk to the parathyroid. I was really glad to have him to consult as we spoke several times that weekend. My surgeon called to follow up on Monday and told me to lower my calcium dose, and felt my body go low again. 
Since then, I have learned to distinguish what low calcium feels like for me so that I can self-regulate. Tingly lips and numb finger tips are one sign. I also watched a you-tube video where the person's hands sort of tensed up out of their control in an almost seizure-like fashion-which is what I think I experienced as lack of dexterity, its like my hands cramp up and I kind of loose control (I'm a knitter and really aware sensations in my hands). There's also a nerve they tap on on the side of your face to watch if it causes a sort of facial tick (Google hypocalcemia, and switch over to video, there's links to a few good ones) Other than that, I found I get really really cranky and unreasonable, have difficulty getting up to doing anything, get a headache, and I sort of start to feel a distance with reality that I can't really explain, I just know what it is now. 
I haven't noticed any problems with my thyroid supplement, so I can't really comment on the difference.


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## desrtbloom (May 23, 2010)

Hi Lavender:

I had a TT four weeks ago. When I was in the hospital, the nurses crushed the calcium pills and put them in chocolate pudding cups for me (I HATE swallowing big pills and my throat was in no condition to do so immediately after the surgery). I could barely even taste it in the pudding (you can get the fat free or sugar free pudding cups).

I now take the Kirkland brand (Costco) sugar-free calcium chew that are 500 mg + D + K each. Since the surgery I am chewing four a day as my first calcium test came back on the low range and I think it is better for me to have it a little higher. Also, two of my parathyroid glands were removed. The other two were replanted in my neck.

I go next Monday to get my second calcium blood work done.

Patti


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## Lovlkn (Dec 20, 2009)

There is a liquid calcium supplement out there - I could not imagine swallowing a bunch of calcium pills.
:hugs:


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## lavender (Jul 13, 2010)

Well, I went to the drug store today since my supply of calcium pills had run out, and I was able to find a smaller tablet in the drug store brand of the caltrate I have been taking. If I take 5, it equals the same amount of calcium and D3 as 4 of the mega size brand name pills, which makes for an equal dose. And, I am able to swallow them, so I think this will work for now. 
I really can't imagine eating pudding 4x a day! I have had no desire for any dairy since my surgery, it just coats my throat and feels really awful! I suppose I could make it with rice milk if I need to go back to crushing. I think I will try swallowing the pills since I can right now.
I know there is liquid calcium and chewable pills. However, my surgeon did not seem to think that they are as good as what I am taking right now. I have been looking at the brands on-line, and it seems that the liquid is a different form of calcium-calcium carbonate, as opposed to the calcium citrate the surgeon wants me to take. From what I have read, the type of calcium seems to affect absorption. I see my endocrinologist on Tuesday, and I will ask him his opinion if one is better than the other. Calcium citrate seems to be available in all sorts of forms-tablet, chewable, liquid, and even chocolate chews. If the endo thinks it is ok, I will give it a try. 
I am concerned about switching because I feel so awful when my calcium goes low, and then it takes a couple of days to go back up, and I really don't want to end up back in the ER for anther IV. 
I just want to know if my calcium levels will ever stabilize, or if this is a life long thing. 16-20 pills a day is a lot to swallow! I think that it will really take some time for my neck to heal to see if my parathyroids kick in again or if this is permanent. I really hope it gets better.


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## Lovlkn (Dec 20, 2009)

lavender said:


> Well, I went to the drug store today since my supply of calcium pills had run out, and I was able to find a smaller tablet in the drug store brand of the caltrate I have been taking. If I take 5, it equals the same amount of calcium and D3 as 4 of the mega size brand name pills, which makes for an equal dose. And, I am able to swallow them, so I think this will work for now.
> I really can't imagine eating pudding 4x a day! I have had no desire for any dairy since my surgery, it just coats my throat and feels really awful! I suppose I could make it with rice milk if I need to go back to crushing. I think I will try swallowing the pills since I can right now.
> I know there is liquid calcium and chewable pills. However, my surgeon did not seem to think that they are as good as what I am taking right now. I have been looking at the brands on-line, and it seems that the liquid is a different form of calcium-calcium carbonate, as opposed to the calcium citrate the surgeon wants me to take. From what I have read, the type of calcium seems to affect absorption. I see my endocrinologist on Tuesday, and I will ask him his opinion if one is better than the other. Calcium citrate seems to be available in all sorts of forms-tablet, chewable, liquid, and even chocolate chews. If the endo thinks it is ok, I will give it a try.
> I am concerned about switching because I feel so awful when my calcium goes low, and then it takes a couple of days to go back up, and I really don't want to end up back in the ER for anther IV.
> I just want to know if my calcium levels will ever stabilize, or if this is a life long thing. 16-20 pills a day is a lot to swallow! I think that it will really take some time for my neck to heal to see if my parathyroids kick in again or if this is permanent. I really hope it gets better.


Exactly how much Calcium are you taking?

I went to Vitacost and they have several liquid calcium supplements that are Calcium Citrate.

I wanted to mention one other thing... are you taking calcium throughout the day rather than all at once?


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## lavender (Jul 13, 2010)

I am taking a total of 10,000mg calcium+6,000IU D3 a day (all in the same supplement). 25,000mg calcium+1500IU D3 4x a day, spaced about 5 hours apart, and waiting at least 3 hours after I take my levothyroxine to start to avoid any interactions. 
I might have to check out vitacost, I didn't visit that site yesterday, and there is really just so much out there....
Unfortunately, I think the switch to generic calcium yesterday was a failure. I woke up several times last night with heart palpitations for the first time since surgery (Pulse 80). I understand this can been a sign of either hyper-t or unbalanced calcium, and I am getting thyroid levels checked tomorrow in preparation for endo appt Wed, which should help clarify things. I also hope that he can give me some input on the calcium. 
Until then, I do not went to mess with what has been working until now, and think I will go back to the drugstore for brand name citracal just to be safe.


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## Lovlkn (Dec 20, 2009)

lavender said:


> I am taking a total of 10,000mg calcium+6,000IU D3 a day (all in the same supplement). 25,000mg calcium+1500IU D3 4x a day, spaced about 5 hours apart, and waiting at least 3 hours after I take my levothyroxine to start to avoid any interactions.
> I might have to check out vitacost, I didn't visit that site yesterday, and there is really just so much out there....
> Unfortunately, I think the switch to generic calcium yesterday was a failure. I woke up several times last night with heart palpitations for the first time since surgery (Pulse 80). I understand this can been a sign of either hyper-t or unbalanced calcium, and I am getting thyroid levels checked tomorrow in preparation for endo appt Wed, which should help clarify things. I also hope that he can give me some input on the calcium.
> Until then, I do not went to mess with what has been working until now, and think I will go back to the drugstore for brand name citracal just to be safe.


YIKES! That is alot of calcium. How is your system handling it? :hugs:


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## lavender (Jul 13, 2010)

YES, now you see what I am getting at...at this rate, I will have all the stores bought out in no time!
glow glow glow glow
I had a very acidic stomach for a while, which I think was a combination of processing the anesthesia, pain meds, anti-nausea med, and laxative I was given to combat narcotic side effects, tylenol, ibuprofen, and constant OJ with calcium. I referred to it as my chemical stew because my belly was not happy!
Now that all that is out of my system, and I have learned to space the calcium 3 hours away from levothyroxine, it has settled down. Also, now that I have stopped crushing, I am not drinking OJ 4x+ a day to get it down, just trying to take calcium with a lot of water around a meal.
I read that constipation was a concern with too much calcium, and that is certainly not my problem. Also some concern about kidney stones if you get too much. 
I spoke with my chiropractor about my concern about taking so much, and she said that I NEED to keep enough calcium in to prevent heart probs, keep up my energy, and prevent bone loss. Also, she confirmed that generic was a bad idea. She suggested I get Vitamin D level checked, and I will ask the endo for an order.
As far as I can tell, I feel better with the calcium. 
arty0049:
I can tell when I do not have enough, I start to get kind of dizzy and headachey, Sometimes my hands feel funny, and I pop an extra one. I go back to get Calcium checked next week, last week it was on the low side of normal at this dose. 
I am just hoping for a better long term answer. I think I will try envisioning my parathyroids healing and send them positive thoughts. I'm not sure there is much I can do for them besides love them back to healthy functioning! It seems they can take months to return to normal functioning as swelling goes down, so all hope is not lost!


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