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Rate of Incidental Parathyroidectomy in a Pediatric Population
Grace Sahyouni1, Beth Osterbauer2, Soyun Park1
1Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Insights
Incidental parathyroidectomy occurred in 31% of pediatric thyroidectomies. Thyroid surgery with lymph node dissection increased this risk, leading to higher rates of long-term hypoparathyroidism.
Area of Science:
- Pediatric Surgery
- Endocrinology
- Surgical Oncology
Background:
- Incidental parathyroidectomy during thyroid surgery is common but understudied in children.
- It can lead to hypoparathyroidism and hypocalcemia, impacting pediatric patients' health.
- Understanding risk factors and outcomes is crucial for improving surgical care.
Purpose of the Study:
- To determine the incidence of incidental parathyroidectomy in pediatric thyroidectomies.
- To identify risk factors associated with this complication.
- To investigate the postoperative outcomes, including hypoparathyroidism, in affected children.
Main Methods:
- Retrospective cohort study of pediatric patients undergoing thyroidectomy over 10 years.
- Review of pathology reports to identify parathyroid gland tissue.
- Collection of demographic, procedural, and clinical outcome data.
Main Results:
- Incidental parathyroidectomy was identified in 65 of 209 (31%) patients.
- Thyroidectomy with lymph node dissection was significantly associated with incidental parathyroidectomy (OR 3.3, P=.04).
- Patients with incidental parathyroidectomy had higher rates of long-term hypoparathyroidism (15% vs 2%, P=.001) after a median 1-year follow-up.
Conclusions:
- Incidental parathyroidectomy is a common occurrence in pediatric thyroid surgery.
- Meticulous surgical technique and parathyroid preservation are key to preventing long-term hypoparathyroidism and hypocalcemia.
- Further research into anatomic, clinical, and surgeon-related factors is warranted.
Objective:
Incidental parathyroidectomy is a relatively common occurrence in thyroid surgery, which may lead to hypoparathyroidism and postoperative hypocalcemia, but it is not well studied in children. The objectives of this study were to determine the rate of incidental parathyroidectomy, identify potential risk factors, and investigate postoperative complications in children undergoing thyroidectomy.
Study Design:
Retrospective cohort study.
Setting:
Patients who underwent thyroidectomy over a 10-year period at a tertiary children's hospital.
Methods:
Pathology reports were reviewed to determine incidental parathyroid gland tissue. Additional data collected included patient demographics, type of procedure, underlying thyroid pathology, as well as immediate and long-term postoperative clinical outcomes.
Results:
Of 209 patients, 65 (31%) had incidental parathyroidectomy. Several variables were associated with incidental parathyroidectomy on univariable analysis. However, in the final multivariable model, only thyroidectomy with lymph node dissection was associated with increased odds of having incidental parathyroidectomy (odds ratio, 3.3; P = .04; 95% CI, 1.1-9.8). After a median follow up of 1 year, a significantly higher percentage of patients with incidental parathyroidectomy had evidence of long-term hypoparathyroidism (9/62 [15%] vs 3/144 [2%], P = .001).
Conclusion:
Incidental parathyroidectomy was relatively common in our pediatric thyroidectomy population, which may be a result of several anatomic, clinical, and surgeon-related factors. Close attention to parathyroid preservation with meticulous surgical technique is the most practical method of preventing long-term hypoparathyroidism and hypocalcemia.
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