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Postoperative Complications After Prophylactic Thyroidectomy for Very Young Patients With Multiple Endocrine
Wouter P Kluijfhout1, Dirk-Jan van Beek, Annemarie A Verrijn Stuart
1From the Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht (WPK, D-JVB, LL, MRV, IHMBR); Department of Pediatric Endocrinology, Wilhelmina Children's Hospital (AAVS); Department of Endocrinology; University Medical Center Utrecht (GDV); and Department of Pediatric Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands (DCVDZ).
Insights
Prophylactic thyroidectomy in very young children with Multiple Endocrine Neoplasia (MEN) 2 is linked to more complications and longer hospital stays. Surgery is not advised before age 3 for high-risk patients.
Area of Science:
- Pediatric Surgery
- Endocrinology
- Genetics
Background:
- Multiple Endocrine Neoplasia (MEN) 2 necessitates prophylactic thyroidectomy.
- Earlier surgery reduces medullary thyroid carcinoma (MTC) risks but may increase complications in very young children.
- Limited data exists on complications in pediatric patients undergoing thyroidectomy before age 3.
Purpose of the Study:
- To investigate the association between younger age at prophylactic thyroidectomy and postoperative complications in pediatric patients with MEN 2.
- To evaluate the incidence of hypocalcemia and other complications in relation to patient age.
- To assess the impact of complications on length of stay (LOS) and recurrence of MTC.
Main Methods:
- Retrospective single-center analysis of 44 pediatric patients with MEN 2 undergoing prophylactic total thyroidectomy (age ≤ 17).
- Patients were stratified into three age groups: <3 years, 3-6 years, and >6 years.
- Postoperative complications, including hypocalcemia and LOS, were recorded and analyzed.
Main Results:
- 27% experienced transient hypocalcemia, and 20% had permanent hypocalcemia; a trend towards higher incidence with decreasing age was observed.
- Patients younger than 3 years had a significantly longer average LOS (6.7 days) compared to older groups.
- Complications were associated with a longer LOS (5.0 vs 2.0 days). No MTC recurrence was noted in any patient after a mean follow-up of 10.5 years.
Conclusions:
- Prophylactic thyroidectomy in very young children (<3 years) with MEN 2 is associated with increased complication rates and significantly longer hospital stays.
- No MTC recurrence was observed, regardless of surgical age.
- Clinicians should consider complication risks and recommend against total thyroidectomy before age 3 for high-risk MEN 2 patients.
Abstract:
The aim of this study was to investigate whether younger age at surgery is associated with the increased incidence of postoperative complications after prophylactic thyroidectomy in pediatric patients with multiple endocrine neoplasia (MEN) 2. The shift toward earlier thyroidectomy has resulted in significantly less medullary thyroid carcinoma (MTC)-related morbidity and mortality. However, very young pediatric patients might have a higher morbidity rate compared with older patients. Hardly any literature exists on complications in the very young. A retrospective single-center analysis was performed on the outcomes of MEN2 patients undergoing a prophylactic total thyroidectomy at the age of 17 or younger. Forty-one MEN2A and 3 MEN2B patients with thyroidectomy after January 1993 and at least 6 months of follow-up were included, subdivided in 9 patients younger than 3 years, 15 patients 3 to 6 years, and 20 patients older than 6 years. Postoperative hypocalcemia and other complications were registered. Twelve (27%) patients developed transient hypocalcemia and 9 (20%) patients suffered from permanent hypocalcemia, with a nonsignificant trend toward higher incidence with decreasing age. Three (7%) patients had other complications, of whom 2 were younger than 3 years. For patients younger than 3 years, the average length of stay (LOS) was 6.7 days, versus 1.7 and 3.5 days, respectively, for the older patient groups (P < 0.05). Patients with complications had a longer LOS compared with patients without (5.0 vs 2.0, P < 0.01). None of the patients had clinical signs of recurrent MTC after a mean follow-up of 10.5 years. Prophylactic thyroidectomy in very young children is associated with a higher rate of complications, causing a significant increased LOS. Irrespective age of surgery, MTC did not recur in any patient. In planning optimal timing of surgery, clinicians should take the risk of complications into account. We advise not to perform total thyroidectomy before the age of 3 for patients defined high risk by the American Thyroid Association guideline.
