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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, Spain.
Insights
Hypoparathyroidism (HP) is a frequent complication after pediatric total thyroidectomy, sometimes requiring permanent calcium supplementation. Younger children may face a higher risk of developing this condition.
Area of Science:
- Pediatric Endocrinology
- Surgical Complications
- Thyroid Surgery
Background:
- Hypoparathyroidism (HP) is a significant complication following total thyroidectomy, with potential for emergency presentation.
- Understanding HP's incidence and characteristics in pediatric patients is crucial for surgical outcomes.
Purpose of the Study:
- To determine the prevalence of HP post-total thyroidectomy in children under 14.
- To identify variables associated with HP development and its clinical manifestations.
- To assess the long-term outcomes of HP in this pediatric cohort.
Main Methods:
- Retrospective analysis of pediatric patients undergoing total thyroidectomy over 20 years.
- HP defined by post-operative calcium supplementation, with permanent HP noted if unresolved within 12 months.
- Statistical comparison of proportions using Fisher's method to analyze risk factors.
Main Results:
- 12 out of 39 pediatric patients developed HP; 3 cases were permanent.
- HP occurred even when parathyroid glands were not intentionally dissected (6/25 cases).
- Younger age (under 6 years) was associated with permanent HP, though not statistically significant (p=0.09).
Conclusions:
- HP is a common and potentially serious complication of pediatric total thyroidectomy.
- HP can manifest even with prophylactic surgery and intact parathyroid glands.
- Younger pediatric patients may represent a higher-risk group for developing permanent HP.
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 3.67-14.00 years. In 25 patients, the intervention was prophylactic and in 14 it was therapeutic; 14 suffered accidental excision of some parathyroid gland, but none more than two of them; 12 presented HP, of which 3 were permanent; 5 presented clinical symptoms; 1 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 = 0.02). In the prophylactic interventions, it was 6/25 compared to 6/14 in the therapeutic ones (p = 0.29). The three cases of permanent HP were in children under 6 years of age, and it did not occur in any older children (p = 0.09).
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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