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Published on: August 17, 2022
Intraoperative parathyroid hormone measurement facilitates outpatient thyroidectomy in children
Ruth Obiarinze1, Jessica Fazendin1, Pallavi Iyer2
1University of Alabama at Birmingham Department of Surgery, Boshell Diabetes Building, 1808 7th Avenue South, Birmingham, AL 35233, USA.
Insights
Intraoperative parathyroid hormone (ioPTH) levels after pediatric thyroidectomy can identify patients at risk for hypoparathyroidism. This measurement, alongside a treatment protocol, enables safe outpatient discharge following surgery.
Area of Science:
- Pediatric Endocrinology
- Surgical Oncology
- Endocrine Surgery
Background:
- Thyroidectomy in children can lead to hypoparathyroidism.
- Accurate monitoring is crucial for managing post-thyroidectomy complications.
Purpose of the Study:
- To evaluate the utility of intraoperative parathyroid hormone (ioPTH) measurement in predicting hypoparathyroidism after pediatric thyroidectomy.
- To assess the feasibility of outpatient procedures based on ioPTH levels and a treatment protocol.
Main Methods:
- Retrospective review of pediatric patients (<21 years) undergoing thyroidectomy between 2015-2019.
- ioPTH levels were used to guide treatment protocols involving calcium and calcitriol supplementation.
- Patients were categorized based on ioPTH concentrations (≥20, 10-19, 5-9, <5 pg/mL).
Main Results:
- Fifty-two pediatric patients were analyzed (median age 16 years).
- 38% of patients exhibited low ioPTH levels (<10 pg/mL).
- 60% of those with low ioPTH normalized levels within two weeks post-surgery.
Conclusions:
- Intraoperative parathyroid hormone measurement is a valuable tool for risk stratification of hypoparathyroidism post-thyroidectomy in children.
- A defined treatment protocol based on ioPTH levels facilitates safe discharge and outpatient management.
- Pediatric thyroid surgery can be safely managed on an outpatient basis using ioPTH monitoring.
Introduction:
We hypothesize that intraoperative parathyroid hormone (ioPTH) measurement after a total thyroidectomy predicts children at risk for hypoparathyroidism and allow for outpatient procedure.
Methods:
Between 2015 and 2019, we reviewed all patients under the age of 21 undergoing a thyroidectomy (total or lobectomy). Based on the ioPTH concentration, the patients were treated by the following protocol: a) PTH ≥20 pg/mL: no treatment; b) PTH = 10-19 pg/mL: 1000 mg calcium orally TID; c) PTH = 5-9 pg/mL: calcitriol 250 μg orally BID plus 1000 mg calcium orally TID; or d) PTH <5 pg/mL calcitriol 500 μg orally BID plus 1000 mg calcium orally TID.
Results:
Fifty-two patients were included with a median age of 16 (range 6-21 years). Thirty-two patients (62%) had normal PTH (≥10 pg/mL) while 20 (38%) had low PTH levels (<10 pg/mL). Of those patients with low PTH, 60% had normalization of levels within 2 weeks of surgery.
Conclusions:
Thyroid surgery in children can be performed as an outpatient procedure. The ioPTH measurements and a protocol to treat patients with low PTH assists in safe discharge.
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