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Risk factors of postoperative hypoparathyroidism after total thyroidectomy in pediatric patients with thyroid cancer
Yunsoo Choe1, Yun Jeong Lee1, Choong Ho Shin1
1Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.
Insights
Hypoparathyroidism after thyroidectomy is common in pediatric thyroid cancer patients. Young age and low preoperative calcium predict long-term vitamin D needs.
Area of Science:
- Pediatric Endocrinology
- Surgical Oncology
- Thyroid Cancer Research
Background:
- Hypoparathyroidism (hypoPTH) is a frequent complication after thyroidectomy.
- Understanding its incidence and risk factors in pediatric thyroid cancer is crucial.
Purpose of the Study:
- To determine the frequency of hypoPTH post-total thyroidectomy (TT) in pediatric thyroid cancer patients.
- To identify risk factors associated with hypoPTH and its persistence.
Main Methods:
- Retrospective analysis of 98 pediatric patients (<20 years) with thyroid cancer undergoing TT (1990-2018).
- HypoPTH defined by the need for active vitamin D supplementation post-surgery.
- Statistical analysis to identify predictors of hypoPTH and persistent hypoPTH.
Main Results:
- HypoPTH occurred in 43.9% of patients.
- Tumor multifocality and lower preoperative calcium levels predicted immediate hypoPTH.
- Younger age and lower preoperative calcium levels predicted persistent hypoPTH requiring long-term vitamin D.
Conclusions:
- Nearly half of pediatric thyroid cancer patients develop hypoPTH after TT.
- A significant proportion require long-term vitamin D supplementation, influenced by age and preoperative calcium.
- These findings highlight the importance of monitoring calcium and vitamin D in this population.
Purpose:
Hypoparathyroidism (hypoPTH) is the most common complication following thyroidectomy. We investigated the frequency and risk factors of hypoPTH after total thyroidectomy (TT) in pediatric patients with thyroid cancer.
Methods:
This retrospective study included 98 patients younger than 20 years who were diagnosed with thyroid cancer after T T during 1990-2018 and followed for more than 2 years at Seoul National University Hospital. HypoPTH was defined as receiving active vitamin D (1-hydroxycholecalciferol or 1,25-dihydroxycholecalciferol) after surgery.
Results:
The study included 27 boys (27.6%) and 71 girls (72.4%). The mean age at diagnosis was 14.9±3.7 years. HypoPTH occurred in 43 patients (43.9%). Twenty-one patients (21.4%) discontinued active vitamin D less than 6 months after surgery, while 14 (14.3%) continued active vitamin D for more than 2 years. Tumor multifocality (odds ratio [OR], 3.7 vs. single tumor; P=0.013) and preoperative calcium level (OR, 0.2; P=0.028) were independent predictors of hypoPTH immediately after TT. In addition, age (OR, 0.8; P=0.011) and preoperative calcium level (OR, 0.04; P=0.014) significantly decreased the risk for persistent hypoPTH requiring active vitamin D for more than 2 years.
Conclusion:
HypoPTH occurred in 43.9% of pediatric thyroid cancer patients after TT in this study. Among them, one-third of patients continued active vitamin D medication for more than 2 years, which was predicted by young age and low preoperative calcium level.
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