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The Effect of Pre-Thyroidectomy Calcitriol Prophylaxis on Post-Thyroidectomy Hypocalcaemia in Children
Lisanne M Vendrig1, Christiaan F Mooij1, Joep P M Derikx2
1Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Insights
Prophylactic calcitriol supplementation before thyroidectomy in children did not prevent hypocalcaemia. While it increased postoperative calcium levels, it did not reduce symptomatic cases or hospital stays.
Area of Science:
- Pediatric Endocrinology
- Surgical Complications
- Calcium Metabolism
Background:
- Hypoparathyroidism is a common complication of total thyroidectomy, potentially causing symptomatic hypocalcaemia.
- In children, post-thyroidectomy hypocalcaemia is typically managed with calcium and vitamin D supplementation.
- Amsterdam UMC implemented prophylactic calcitriol before thyroidectomy in children in 2013.
Purpose of the Study:
- To evaluate the effectiveness of prophylactic pre-thyroidectomy calcitriol supplementation.
- To determine if calcitriol prevents post-thyroidectomy hypocalcaemia in pediatric patients.
Main Methods:
- Retrospective case study of children (<18 years) undergoing total thyroidectomy (2000-2020).
- Comparison of patients with and without preoperative calcitriol supplementation.
- Hypocalcaemia defined as serum calcium <2.0 mmol/L; primary outcome: hypocalcaemia within 72 hours post-surgery.
Main Results:
- 51 patients included: 26 with calcitriol prophylaxis, 25 controls.
- No significant difference in hypocalcaemia occurrence (17/26 vs. 18/25).
- Higher median postoperative calcium concentrations observed in the prophylaxis group at 30-35h and 36-41h.
Conclusions:
- Prophylactic calcitriol led to higher postoperative calcium levels but did not decrease hypocalcaemia incidence.
- Calcitriol supplementation did not significantly impact symptomatic hypocalcaemia or hospitalization length.
- The study suggests calcitriol prophylaxis may not be effective in preventing post-thyroidectomy hypocalcaemia in children.
Introduction:
Transient or persistent hypoparathyroidism is one of the most well-known complications of total thyroidectomy and may lead to symptomatic hypocalcaemia. In children, treatment of post-thyroidectomy hypocalcaemia usually consists of postoperative calcium and/or vitamin D supplementation. In 2013, we implemented prophylactic pre-thyroidectomy calcitriol supplementation for all children undergoing total thyroidectomy at the Amsterdam UMC. The objective of this study was to evaluate the efficacy of this prophylactic calcitriol supplementation in preventing post-thyroidectomy hypocalcaemia in children.
Methods:
In a retrospective case study, we included all children (age <18 years), who underwent a total or completion thyroidectomy in the Amsterdam UMC, between 2000 and 2020. Patients were divided into two groups, patients with preoperative calcitriol supplementation and those without (controls). Hypocalcaemia was defined as total serum calcium concentration of <2.0 mmol/L. The primary outcome measure was the occurrence of hypocalcaemia in the first 72 h after surgery. Secondary outcome measures were occurrence of symptomatic hypocalcaemia, need for medical intervention within the first 72 h after surgery, and length of hospitalization.
Results:
A total of 51 patients were included; 26 with calcitriol prophylaxis and 25 controls. There was no significant difference in occurrence of hypocalcaemia (17/26 prophylaxis group; 18/25 control group). Median postoperative calcium concentrations in the first 72 h were significantly higher in the group with prophylaxis at 30-35 h (2.26 vs. 2.01 mmol/L) and 36-41 h (2.17 vs. 1.92 mmol/L). Occurrence of symptomatic hypocalcaemia, need for medical intervention, and length of hospitalization were not significantly different between the groups.
Conclusion:
Calcitriol prophylaxis resulted in somewhat higher postoperative calcium concentrations but did not reduce the occurrence of hypocalcaemia or affect clinical outcome measures such as occurrence of symptomatic hypocalcaemia and length of postoperative hospitalization.
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