123 https://jes-online.org We read with great interest the article by Picchio et al. (1) on the preventive efect of multiple doses post-operative betamethasone administration on thyroidectomy-related complications. This study has shown that post-operative betamethasone administration signifcantly reduces the incidence of biochemical and symptomatic hypocalcemia. Several predisposing factors were introduced: direct trauma, calcitonin release following thyroid manipulation, pain-induced hyperventilation, and alkalosis (1). We presume that intra- operative hypoperfusion could also be a contributing factor. Hypoperfusion leads to local infammation and temporary parathyroid glands failure. This infammation could also activate the local coagulation cascade and subsequently induce parathyroid vascular insufciency via forming local microthrombi. Moreover, this study suggests that the corticosteroids were inefective in preventing post- operative voice changes. Several mechanisms lead to dysphonia following thyroidectomy: arytenoid or surgical trauma, changing laryngeal blood supply, and direct trauma (with any severity) to the recurrent laryngeal nerve (RLN) (2). Therefore, it seems that late RLN dysfunction- without total or partial paralysis- is mainly a response to the intra-operative insults and the resultant infammations. Due to the limited recovery potential of neurons, we presumed that the post-operative administration of corticosteroid could not salvage neuronal function. Our hypothesis is partially supported by 2 previously conducted randomized controlled trials. These trials showed a temporary voice improvement (signifcantly in the frst 24 hours post-operation) following a single dose of pre-operative administration of dexamethasone (half-life=1.8–3.5 hours) (3,4). Considering these factors, the surgeons should suppress the immune system before the thyroidectomy to prevent further complications. We suggest the following regimen: Dexamethasone injection (8 mg/2 mL) 1 hour pre-operation and every 8 hours during the frst day afer the thyroidectomy. Furthermore, we recommend prescribing long- acting betamethasone on the second day following the surgery to prevent delayed onset infammation. In addition, 300,000 IU of vitamin D3 supplements 2 hours afer surgery J Endocr Surg. 2021 Dec;21(4):123-124 https://doi.org/10.16956/jes.2021.21.4.123 pISSN 2508-8149·eISSN 2508-8459 Short Communication Received: Oct 18, 2021 Revised: Dec 2, 2021 Accepted: Dec 3, 2021 Correspondence to Roham Borazjani Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Chamran Blvd, Shiraz 71948-15711, Iran. E-mail: rohamborazjani@gmail.com Copyright © 2021. Korean Association of Thyroid and Endocrine Surgeons; KATES This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https:// creativecommons.org/licenses/by-nc/4.0/). ORCID iDs Shahram Paydar https://orcid.org/0000-0002-6980-2576 Roham Borazjani https://orcid.org/0000-0001-5391-2490 Hamid Reza Abbasi https://orcid.org/0000-0003-0090-650X Shahram Bolandparvaz https://orcid.org/0000-0002-8875-5998 Mohammad Hossein Dabbaghmanesh https://orcid.org/0000-0002-4877-0376 Conflict of Interest No potential confict of interest relevant to this article was reported. Shahram Paydar 1 , Roham Borazjani 1 , Hamid Reza Abbasi 1 , Shahram Bolandparvaz 1 , Mohammad Hossein Dabbaghmanesh 2 1 Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran 2 Endocrinology and Metabolism Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran Letter to the Editor: Betamethasone to Prevent Symptomatic Hypocalcaemia and Other Complications after Total Thyroidectomy: a Case-control Study ► See the article “Betamethasone to Prevent Symptomatic Hypocalcaemia and Other Complications after Total Thyroidectomy: a Case-control Study” in volume 21 on page 61.