Improving safety in paediatric thyroidectomy by PTH measurements
Analía V Freire1, María G Ropelato1, Patricia Papendieck1
1Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE) -CONICET - FEI - División de Endocrinología, Hospital de Niños "Ricardo Gutiérrez", Buenos Aires, Argentina.
Insights
This study shows that using parathyroid hormone (PTH) levels to predict hypocalcemia after thyroidectomy is safe and effective. This strategy reduces hypocalcemia incidence and hospital stays in pediatric patients.
Area of Science:
- Endocrinology
- Pediatric Surgery
- Oncology
Background:
- Post-thyroidectomy hypocalcemia is a common complication.
- Predicting and managing hypocalcemia is crucial for patient recovery.
- Current management strategies may lead to prolonged hospital stays and unnecessary testing.
Purpose of the Study:
- To evaluate an algorithm using pre- and post-operative parathyroid hormone (PTH) levels to predict hypocalcemia.
- To assess the safety and efficacy of this strategy in reducing hypocalcemia, hospitalisation length, and calcium sampling.
- To determine its utility in pediatric patients undergoing thyroidectomy.
Main Methods:
- A risk stratification algorithm based on intraoperative and postoperative PTH levels was applied to 66 pediatric patients.
- High-risk patients received calcium and vitamin D1-25 supplementation.
- Low-risk patients were monitored with daily calcium sampling for up to 48 hours post-surgery.
- Outcomes were compared to a historical control group.
Main Results:
- The incidence of hypocalcemia in high-risk patients decreased from 100% to 17% (p < .001).
- Median hospitalisation length reduced from 6 to 3 days (p < .001).
- Overall incidence of hypocalcemia decreased by 58% compared to controls.
- Neck dissection was identified as a significant risk factor for postsurgical hypoparathyroidism (RR: 2.1).
Conclusions:
- Utilizing PTH levels for risk assessment and preemptive therapy is an effective strategy.
- This approach enhances patient safety by reducing hypocalcemia and hospitalisation duration post-thyroidectomy.
- The algorithm proved beneficial in managing pediatric patients, improving outcomes and resource utilization.
Objetive:
We followed our previously reported algorithm based on intra and postoperative parathyroid hormone (PTH) levels to predict postthyroidectomy hypoparathyroid hypocalcemia. The objective of the study was to assess if this strategy is useful and safe to reduce hypocalcemia, hospitalisation length and postsurgery calcium sampling.
Design, Patients, Meassurements:
We classified our series of 66 patients according to their risk of hypoparathyroidism based on PTH determinations. We treated high-risk patients with calcium and vitamin D1-25 supplementation and obtained routine daily calcium samples to control low-risk patients until 48 h postsurgery. We compared the outcomes and overall results of this new approach with those of a historical control group of patients with equivalent PTH measurements who were treated only if they presented hypocalcemia.
Results:
In the high-risk subgroup (n = 30), five patients had hypocalcemia within the first 24 h. Compared with the high-risk control subgroup, the incidence of hypocalcemia fell from 100% to 17% (p < .001), and the median hospitalisation length from 6 to 3 days (p < .001). In the low-risk subgroup (n = 36), 28 patients remained normocalcemic with significantly less calcium sampling (p < .001). Eight patients had hypocalcemia; seven of them required neck dissection, which was the only risk factor related to postsurgical hypoparathyroidism (RR: 2.1 [confidence interval 95%: 1.4-3.1]; p < .001). The overall incidence of hypocalcemia decreased by 58% in our patients compared to the control group.
Conclusions:
Assessing PTH levels to classify the risk of hypoparathyroidism and to initiate preventive therapy was an effective approach that improved the safety of our paediatric patients by reducing the incidence of hypocalcemia and the length of hospitalisation after thyroidectomy in paediatric patients.
