Mercante G, Anelli A, Giannarelli D, et al. - In this multicenter, prospective randomized study, researchers compared three different strategies [“preventive” (oral calcium + vitamin D supplementation), “reactive” (therapy in hypocalcemia), and “predictive” (therapy if iPTH <10 pg/mL)] for managing transient hypocalcemia following total thyroidectomy to assess cost-effectiveness and to analyze the reliability of total serum calcium (TSCa), ionized calcium (ICa), and intact parathyroid hormone (iPTH). The study sample consisted of 169 patients. In identifying patients with hypocalcemia-related symptoms, TSCa was more accurate than ICa. TSCa 24 h after surgery exhibited 24.8% of patients with hypocalcemia, while TSCa 48 h after surgery identified a further 10.6% with hypocalcemia (only in the “reactive” and “predictive” groups). As a predictor of hypocalcemia, iPTH showed low sensitivity. No significant difference was found in hospitalization time or number of symptomatic hypocalcemic patients between the 3 groups. None of the strategies discussed permitted patients to be discharged soon without any risk of transient hypocalcemia. Despite overtreatment, the "preventive" strategy has been the most cost-effective.