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Permanent Hypoparathyroidism After Total Thyroidectomy in Children: Results from a National Registry
Erik Nordenström1, Anders Bergenfelz2, Martin Almquist2
1Department of Clinical Science, Lund University, 221 85, Lund, Sweden. erik.nordenstrom@skane.se.
Insights
Permanent hypoparathyroidism is a common complication after pediatric thyroidectomy. This study found a high incidence of this condition in children, highlighting a significant concern for post-surgical care and long-term outcomes.
Area of Science:
- Pediatric endocrinology
- Surgical outcomes
- Public health
Background:
- Hypoparathyroidism is a frequent complication after thyroidectomy.
- Data on pediatric hypoparathyroidism rates post-thyroidectomy are limited.
- This study investigates the incidence of permanent hypoparathyroidism in children.
Purpose of the Study:
- To determine the incidence of permanent hypoparathyroidism in children undergoing total thyroidectomy.
- To identify potential risk factors for permanent hypoparathyroidism in this pediatric population.
- To compare hospital readmission rates and duration of hospital stay between children with and without permanent hypoparathyroidism.
Main Methods:
- Analysis of data from the Scandinavian Quality Registry for Thyroid, Parathyroid and Adrenal Surgery (2004-2014).
- Inclusion of pediatric patients (<18 years) who underwent total thyroidectomy, excluding those with prior surgery or vitamin D treatment.
- Definition of permanent hypoparathyroidism as vitamin D treatment for over 6 months post-surgery; logistic regression for risk factors; comparison of inpatient data.
Main Results:
- 274 children underwent total thyroidectomy; 7.3% developed permanent hypoparathyroidism.
- No statistically significant risk factors for permanent hypoparathyroidism were identified.
- Readmission rates and hospital days were similar for children with and without permanent hypoparathyroidism.
Conclusions:
- The incidence of permanent hypoparathyroidism following pediatric total thyroidectomy is notably high.
- This high rate warrants attention and suggests a need for improved management strategies.
- Further research may be needed to understand and mitigate this complication.
Introduction:
Hypoparathyroidism is the most common complication following thyroidectomy. There are few population-based reports on the rate of hypoparathyroidism in children. The incidence of medical treatment of permanent hypoparathyroidism in children is reported using a national registry.
Methods:
The study population included patients below 18 years of age undergoing total thyroidectomy reported to the Scandinavian Quality Registry for Thyroid, Parathyroid and Adrenal Surgery 2004-2014. Patients with previous thyroid or parathyroid surgery or treatment with vitamin D before surgery were excluded from analysis. Permanent postoperative hypoparathyroidism was defined as treatment with vitamin D for more than 6 months after thyroidectomy. Risk factors for permanent hypoparathyroidism were calculated with uni- and multivariable logistic regression. Using data from the Swedish Inpatient Registry, rates of readmissions and annual number of days in hospital after total thyroidectomy were compared between patients with and without permanent hypoparathyroidism.
Results:
Some 274 children (215 girls and 59 boys) underwent total thyroidectomy. The median age was 14 (range 0-17) years. Indications for surgery were Graves' disease (214, 78.1%), other benign disease (27, 9.9%) and thyroid cancer (33, 12%). Median follow-up was 4.8 years. Twenty (7.3%) children developed permanent hypoparathyroidism. No statistically significant risk factors for permanent hypoparathyroidism were identified. Rates of readmission and annual number of days in hospital after discharge were similar in patients with and without permanent hypoparathyroidism.
Conclusions:
The rate of permanent hypoparathyroidism following total thyroidectomy in children was high and is a cause of concern.
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