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Hypoparathyroidism after thyroidectomy: A 20-year experience at a children's hospital
Emilio García-García1, Ana L Gómez-Gila1, Ana R Romero-Lluch2
1Unidad de Endocrinología Pediátrica, Hospital Virgen del Rocío, Sevilla, España.
Insights
Hypoparathyroidism (HP) is a common complication after pediatric total thyroidectomy. Even with prophylactic surgery and intact parathyroid glands, HP can occur and may be permanent, especially in younger children.
Area of Science:
- Pediatric Endocrinology
- Surgical Complications
- Thyroid Surgery
Background:
- Hypoparathyroidism (HP) is a frequent complication following total thyroidectomy, posing potential emergency risks.
- Understanding HP's incidence and characteristics in pediatric patients is crucial for managing this common post-surgical issue.
Purpose of the Study:
- To determine the prevalence of HP after total thyroidectomy in children under 14.
- To identify variables associated with HP development and describe its clinical presentation in this age group.
Main Methods:
- Retrospective analysis of pediatric patients undergoing total thyroidectomy over 20 years.
- HP defined by calcium supplementation need post-surgery; permanence assessed at 12 months.
- Statistical comparison of proportions using Fisher's method.
Main Results:
- Twelve of 39 pediatric patients developed HP; 3 cases were permanent.
- Accidental parathyroid gland excision occurred in 14 patients; none lost more than two glands.
- HP incidence was linked to parathyroid dissection (P=.02); younger children (<6 years) showed a trend towards permanent HP (P=.09).
Conclusions:
- HP is a significant and potentially permanent complication of pediatric total thyroidectomy.
- HP can occur even with prophylactic surgery and preserved parathyroid glands.
- Younger age appears to be a risk factor for developing permanent HP post-thyroidectomy.
Introduction:
Hypoparathyroidism (HP) is the most common complication of total thyroidectomy and can be an emergency.
Objectives:
To describe the prevalence of HP after total thyroidectomy in children under 14 years of age, the variables related to its appearance and its clinical expression.
Patients And Methods:
Retrospective study at a children's hospital in the last 20 years. HP was defined by the need to supplement calcium after the intervention and was considered permanent if it could not be suspended within 12 months. Fisher's statistical method of comparison of proportions.
Results:
Thirty-nine children and adolescents (26 females) with an age range of 3.67 to 14.00 years. In 25 patients, the intervention was prophylactic and in 14 it was therapeutic. Fourteen suffered accidental excision of some parathyroid gland, but none more than t2 of them. Twelve presented HP, of which 3 were permanent; 5 presented clinical symptoms; one of them was an emergency. The frequency of HP was 4/4 when 2 parathyroids were dissected, 2/10 when one was dissected, and 6/25 when none were dissected (P=.02). In the prophylactic interventions, it was 6/25 compared to 6/14 in the therapeutic ones (P=.29). The 3 cases of permanent HP were in children under 6 years of age, and it did not occur in any older children (P=.09).
Conclusions:
HP is a common and sometimes serious complication in children after total thyroidectomy. It can occur, and even be permanent, even if the intervention is prophylactic and parathyroid glands remain in situ. Younger age could be a risk factor.
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