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Pediatric thyroidectomy in a high volume thyroid surgery center: Risk factors for postoperative hypocalcemia
Yufei Chen1, Peter T Masiakos1, Randall D Gaz1
1Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
Insights
Postoperative hypocalcemia is a risk after pediatric thyroid surgery. Total thyroidectomy, extensive dissections, Graves' disease, and malignancy increase this risk, requiring vigilant monitoring and supplementation.
Area of Science:
- Pediatric Endocrinology
- Surgical Oncology
- Head and Neck Surgery
Background:
- Hypocalcemia is a frequent complication after thyroid surgery.
- Pediatric thyroidectomy incidence and outcomes require further investigation.
Purpose of the Study:
- To assess the incidence of postoperative hypocalcemia in pediatric thyroidectomy patients.
- To identify risk factors associated with hypocalcemia after pediatric thyroid surgery.
Main Methods:
- Retrospective review of 171 pediatric patients (aged ≤18) undergoing 186 thyroid operations (1992-2013).
- Primary endpoints included nadir calcium <8.0mg/dL, need for calcium supplementation, and permanent hypoparathyroidism.
Main Results:
- Postoperative hypocalcemia occurred in 12.9% of patients (24/171), with 7.0% (13/171) requiring intravenous calcium.
- Permanent hypoparathyroidism was rare (0.9%, 1/171).
- Risk factors identified: total thyroidectomy (OR 7.39), extensive neck dissection (OR 22.26), Graves' disease (OR 3.99), and malignancy (OR 2.96).
Conclusions:
- Pediatric patients undergoing total thyroidectomy for malignancy or Graves' disease, and those with extensive nodal dissections, face a higher risk of hypocalcemia.
- Vigilant preoperative preparation and postoperative calcium/vitamin D supplementation are recommended for high-risk pediatric patients.
Introduction:
Hypocalcemia is a common complication following thyroid surgery. We seek to report on our experience in pediatric thyroidectomy in a high volume thyroid surgery center and accurately assess the incidence of postoperative hypocalcemia.
Materials And Methods:
A retrospective review of patients aged 18 and younger who underwent thyroid surgery between 1992 and 2013. The primary endpoints were the occurrence of postoperative hypocalcemia as by defined as a nadir calcium <8.0mg/dL and being discharged on oral calcium supplementation, need for intravenous calcium and the occurrence of permanent hypoparathyroidism.
Results:
171 patients who underwent 186 thyroid operations were analyzed. The average age was 15.4years with 82.3% female. The most common indications for surgery were nodular disease (74.7%) and hyperthyroidism (12.4%). 24 patients (12.9%) experienced postoperative hypocalcemia with 13 (7.0%) requiring intravenous calcium infusion. One patient (0.9%) experienced permanent hypoparathyroidism. Risk factors for postoperative hypocalcemia included total thyroidectomy (OR 7.39, p<0.01), central and bilateral lateral neck dissection (OR 22.26, p=0.01), Graves' disease (OR 3.99, p=0.02), and malignancy (OR 2.96, p=0.03).
Conclusions:
Pediatric patients who undergo total thyroidectomy for underlying malignancy or Graves' disease and those who have more extensive nodal dissections are at increased risk of developing this postoperative hypocalcemia. These patients may benefit from more vigilant preoperative preparation and postoperative calcium and vitamin D supplementation.
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