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Risk factors for the development of hypocalcemia in pediatric patients after total thyroidectomy - A systematic
Kung-Ting Kao1, Elspeth C Ferguson2, Geoff Blair3
1Department of Endocrinology and Diabetes, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, VIC, 3052, Australia; Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia; Department of Paediatrics, University of Melbourne, 50 Flemington Road, Parkville, VIC, 3052, Australia.
Insights
Post-thyroidectomy hypocalcemia is common in children. Intraoperative parathyroid hormone (PTH) levels may help predict this complication, but consistent clinical risk factors remain unclear, necessitating further pediatric research.
Area of Science:
- Pediatric Endocrinology
- Surgical Complications
- Calcium Metabolism
Background:
- Post-thyroidectomy hypocalcemia is a frequent complication in pediatric patients, leading to increased morbidity.
- Identifying predictive factors for hypocalcemia is crucial for improving patient outcomes after thyroid surgery.
Purpose of the Study:
- To review and identify factors that predict the occurrence of hypocalcemia in children and adolescents following total thyroidectomy.
Main Methods:
- A comprehensive literature search was conducted across major databases (Medline, CINAHL, EMBASE, Web of Science, Cochrane Library) for pediatric studies (≤18 years) published between 1970 and 2020.
- Studies focusing on total, subtotal, or completion thyroidectomy with defined hypocalcemia criteria (serum total calcium <2.0 mmol/L or ionized calcium <1.0 mmol/L) were included.
- Study quality was assessed using the Newcastle-Ottawa scale, and results were summarized, with meta-analyses performed where appropriate.
Main Results:
- Five studies involving 477 pediatric patients were included, reporting higher rates of transient (22%) versus permanent (10%) hypocalcemia.
- Intraoperative parathyroid hormone (PTH) levels were identified as potentially useful predictors in two studies.
- Conflicting results were found regarding other potential risk factors; some studies suggested neck dissection and male sex were associated with hypocalcemia, while others found no significant association with factors like age, sex, hospital volume, or operative details.
Conclusions:
- Intraoperative PTH monitoring may aid in predicting hypocalcemia after pediatric total thyroidectomy.
- The current pediatric literature lacks consistent evidence for clinical risk factors or effective preventative strategies for post-thyroidectomy hypocalcemia.
- There is an urgent need for high-quality pediatric research to address these knowledge gaps.
Objectives:
Post-thyroidectomy hypocalcemia is a common complication that causes increased morbidity. This review aims to identify the factors that predict occurrence of hypocalcemia after total thyroidectomy in children and adolescents.
Methods:
Comprehensive searches of English language pediatric (≤18 years of age) articles were performed in Medline, CINAHL, EMBASE, Web of Science and the Cochrane Library. Studies published between January 1, 1970 to August 20, 2020 regarding risk factors and strategies to prevent hypocalcemia were included if the study: 1. included only pediatric patients who were ≤18 years of age, 2. included only patients who had total, subtotal or completion thyroidectomy, 3. defined hypocalcemia as serum total calcium of <2.0 mmol/L (8 mg/dL) or ionized calcium of <1.0 mmol/L. The quality of included papers was assessed using the Newcastle-Ottawa scale. Results of all included studies were summarised. Meta-analyses were performed if appropriate.
Results:
Five studies with a total of 477 patients between 0 and 18 years, who had total/subtotal/completion thyroidectomy, were included. Overall rates of transient hypocalcemia were higher than permanent hypocalcemia (transient n = 104, 22%; permanent n = 48, 10%). Two studies found intraoperative parathyroid hormone (PTH) useful in predicting hypocalcemia. While two single institution cohort studies reported that neck dissection, male sex and a lower Parathyroid Gland Remaining In Situ score were associated with hypocalcemia, two other studies, including one population-based cohort study, reported that age at surgery, patient sex, hospital volume, type of thyroid disease, number of identified parathyroid glands, parathyroid auto-transplantation, operation time, thyroid specimen weight, and lymph node dissection were not risk factors for hypocalcemia.
Conclusion:
Intraoperative PTH may be useful in predicting hypocalcemia in children after total thyroidectomy. No consistent clinical risk factors or preventative methods were identified in the pediatric literature. High-quality pediatric research is urgently required to address this knowledge gap.
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