Perioperative outcomes in children with Hashimoto's thyroiditis undergoing total thyroidectomy

Area of Science:

• Pediatric Endocrinology
• Pediatric Surgery
• Otolaryngology

Background:

• Hashimoto's thyroiditis (HT) affects 1-2% of children, with thyroidectomy posing risks due to inflammation.
• Complications of thyroidectomy in pediatric HT patients are not well-established.
• This study compares complication rates in children with and without HT undergoing total thyroidectomy.

Purpose of the Study:

• To evaluate complication rates of total thyroidectomy in pediatric patients with Hashimoto's thyroiditis (HT).
• To compare outcomes between children with HT and those without HT undergoing thyroidectomy.
• To identify specific risks associated with thyroidectomy in children with HT.

Main Methods:

• Retrospective cohort study of pediatric patients undergoing total thyroidectomy.
• Inclusion of high-volume pediatric otolaryngologists between 2014 and 2021.
• Comparison of complication rates between patients with and without preoperative HT diagnosis.

Main Results:

• Children with HT had higher rates of low parathyroid hormone levels (60% vs 26%) and symptomatic hypocalcemia (67% vs 27%).
• HT patients required more oral (80% vs 35%) and intravenous (60% vs 22%) calcium supplements post-surgery.
• Rates of permanent hypocalcemia and recurrent laryngeal nerve paralysis were similar between groups.

Conclusions:

• Thyroidectomy in children with HT carries a low risk of permanent complications.
• Pediatric HT patients are more prone to transient symptomatic hypocalcemia and require increased calcium supplementation post-thyroidectomy.
• Perioperative protocols should be tailored to optimize calcium levels in children with HT undergoing thyroidectomy.