The most important things to know about low calcium symptoms are:
The purpose of a parathyroid operation (in almost all cases) is to lower the blood calcium by removing a tumor. The trick to a great recovery is to manage this drop in calcium so it happens gradually over a few days or a week. If the drop is too quick, people can get symptoms of low calcium and it makes them uncomfortable.
Thus, after doing a zillion parathyroid operations, we have developed post-op calcium protocol that most surgeons in the world use, starting with calcium pills right after surgery and giving a tapering amount for 2 weeks (our default is 5 pills per day for the first week as discussed elsewhere).
If our patients take these pills, very few will get symptoms of low calcium. In fact, only about 1 in 20 of our patients will get any symptoms of low calcium. Your calcium level is going to drop after surgery (that’s what we want!) but your body isn’t used to the lower calcium level, and it doesn’t like rapid changes – even if the calcium level is just going back to normal. Often it isn’t that the calcium is “low”, instead it is lower than what you are used to. So if you have symptoms, you just take more calcium pills.
Your normal parathyroid glands are dormant
Your normal parathyroid glands are dormant, and need time to wake up. Most of our patients have had a parathyroid tumor for at least 4-5 years (some more than a decade). Therefore, your normal glands haven’t done anything (they go to sleep) for many years! It will take these normal glands a couple of days (or a week or so in some cases) to fully function normally.
We can usually predict who is more likely to have symptoms of low calcium, and often we start these folks on more than 5 pills per day. Occasionally we will start somebody on 8 or 9 calcium pills per day, based upon their disease.
The following people are more likely to get symptoms of low calcium:
- Those with calcium levels starting out above 12.0 mg/dl (3.5 mmol/l).
- Those with very old, large tumors.
- Those who have had prior parathyroid surgery (because they likely had one or more parathyroid glands removed already).
These are the folks that we often start on more than 5 pills per day. No worries! We have this all figured out and we will address it with you before you go home, or when we call you the night of surgery. If we think you need more than 5, we will let you know, but usually this is not even one patient per day, so do NOT think it is going to be you.
Are low calcium symptoms dangerous?
Getting symptoms of low calcium is not dangerous; it just means that you need to take more calcium. It is very rare for one of our patients to need to go to the emergency room (less than one in every 4000 cases). Call us on our cell phones so we can help you. We tell all of our patients (and provide it to you in writing in your post op instructions sheet) that if you think you have low calcium symptoms, then take more calcium. You can take up to 10 pills per day without calling us. So do it. BUT, remember, there is no such thing as symptoms of low calcium the first 2 days after surgery. And the symptoms of low calcium are not in the feet or legs.
We see it as a “good” thing
Remember that having low calcium symptoms simply means that you are cured of a disease that you had for many years and that all the calcium you are taking is going right into your bones–which is a good thing. So don’t look at this as a bad thing, look at it like it is a good thing and a great opportunity to give your bones more calcium.
Low calcium symptoms only last a day or two
Some people freak out thinking they are going to have hypoparathyroidism and low calcium forever. If you are our patient, the chances of that happening are very close to zero. Low calcium symptoms will typically last 24-48 hours. For most people, it is one day–they take some extra pills and it goes away and never comes back. Occasionally somebody will have the symptoms for 3-4 days, but that is quite uncommon. Again, the people at risk for this are listed above. Our routine patient should never worry about low calcium issues.
We are a phone call away
Of course, we are never further away than a phone call, so if you are concerned, give one of the nurses a call during the day, or a doctor a call after hours. You will be given all of the doctors’ cell phone numbers when you arrive at the hospital.