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Perioperative determinants of transient hypocalcemia after pediatric total thyroidectomy
Yangyang R Yu1, Sara C Fallon1, Jennifer L Carpenter1
1Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030.
Insights
Younger age, hyperthyroidism, and lymphadenectomy during pediatric total thyroidectomy increase the risk of transient hypocalcemia. Malignant cases with central or lateral lymphadenectomy also face higher risks.
Area of Science:
- Pediatric Surgery
- Endocrinology
- Oncology
Background:
- Total thyroidectomy is a critical procedure in pediatric patients.
- Hypocalcemia is a common complication following this surgery.
- Identifying predictive factors for hypocalcemia is crucial for patient management.
Purpose of the Study:
- To identify risk factors associated with hypocalcemia after pediatric total thyroidectomy.
- To analyze perioperative variables that may predict transient hypocalcemia.
Main Methods:
- Retrospective review of pediatric patients (<21 years) undergoing total thyroidectomy (2002-2016).
- Definition of hypocalcemia: serum calcium <8mg/dL or ionized calcium <1.0mmol/L.
- Multivariate logistic regression analysis to identify perioperative risk factors.
Main Results:
- 34% of 91 pediatric patients experienced transient hypocalcemia.
- Key predictors identified: younger age (OR 0.87), lymphadenectomy (OR 6.6), and hyperthyroidism (OR 13.3).
- Malignancy with central (OR 7.1) or central plus lateral lymphadenectomy (OR 6.33) significantly increased risk.
Conclusions:
- Younger age, hyperthyroidism, and lymphadenectomy are significant risk factors for transient hypocalcemia post-thyroidectomy.
- Pediatric patients with malignancy undergoing lymphadenectomy require vigilant monitoring.
- Proactive perioperative management of hypocalcemia is recommended for high-risk individuals.
Purpose:
We seek to identify risk factors associated with hypocalcemia after pediatric total thyroidectomy.
Methods:
We retrospectively reviewed patients younger than 21years undergoing total thyroidectomy between January 2002 and January 2016. We defined hypocalcemia as any serum calcium <8mg/dl or ionized calcium <1.0mmol/L. Perioperative risk factors were identified through multivariate logistic regression.
Results:
Ninety-one children underwent total thyroidectomy. The average age was 13.7±4.4years, and 77% were female. Transient hypocalcemia was diagnosed in 34% (n=31) of patients. There was one case of permanent hypoparathyroidism. Predictors of transient hypocalcemia included age (OR 0.87, 95% CI 0.8-0.97, p=0.01), lymphadenectomy (OR 6.6, 95% CI 1.7-31.6, p=0.01), and hyperthyroidism (OR 13.3, 95% CI 1.3-1849, p=0.03). Patients with malignancy undergoing central (OR 7.1, 95% CI 1.5-33.4, p=0.01) or central plus lateral lymphadenectomy (OR 6.33, 95% CI 1.0-40.1, p=0.05) had significantly increased risk for transient hypocalcemia. Malignancy, MEN2A/B, goiter, preoperative calcium supplementation, incidental parathyroid removal, and postoperative PTH <15pg/ml were not associated with transient hypocalcemia.
Conclusions:
Younger age, hyperthyroidism, and concomitant lymphadenectomy during total thyroidectomy increase risk of developing transient hypocalcemia. Malignant cases with central or central plus lateral lymphadenectomy are also at increased risk. Aggressive perioperative management of hypocalcemia should be initiated in patients with these risk factors.
Level Of Evidence:
2b.
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