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Published on: July 14, 2023
Influencing Factors of Hypoparathyroidism After Thyroidectomy in Children
Liu Yuwei1, Long Ting1, Pang Wei1
1Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, China.
Insights
Hypoparathyroidism (HP) recovery in children after thyroid cancer surgery is often within six months. Low parathyroid hormone (PTH) levels on day one and lymph node metastasis are key risk factors for delayed HP recovery.
Area of Science:
- Pediatric Endocrinology
- Surgical Oncology
- Endocrinology
Background:
- Hypoparathyroidism (HP) is a frequent complication following total thyroidectomy.
- Thyroid cancer is a primary indication for total thyroidectomy in pediatric patients.
Purpose of the Study:
- To investigate the recovery patterns of HP in children post-thyroidectomy for cancer.
- To identify factors influencing HP recovery after pediatric total thyroidectomy.
Main Methods:
- Retrospective analysis of 121 pediatric patients undergoing total thyroidectomy for thyroid cancer (2016-2020).
- Evaluation of clinical data, tumor characteristics, surgical details, and lymph node status.
- Long-term follow-up (>1 year) to record parathyroid hormone (PTH) recovery timelines.
- Multivariate regression analysis to determine independent risk factors for HP recovery.
Main Results:
- HP occurred in 28.1% of patients (34/121), with an average age of 10.34 years.
- Most patients (73.5%) recovered HP within six months; 5.9% recovered after one year, and 5.9% remained unrecovered after two years.
- Low PTH levels (≤1) on postoperative day one and bilateral central lymph node metastasis were significant risk factors for HP recovery.
Conclusions:
- Bilateral central lymph node metastasis and initial low PTH levels are independent risk factors impacting HP recovery.
- HP recovery can occur beyond six months, necessitating careful consideration for diagnosing permanent HP.
Abstract:
Objective: Hypoparathyroidism (HP) is the most common complication after total thyroidectomy. The purpose of this study was to summarize the recovery of HP in children after total thyroidectomy for thyroid cancer and to explore the related influencing factors. Methods: HP was identified in children who underwent total thyroidectomy for thyroid cancer between 2016 and 2020. Clinical characteristics, tumor stage, intraoperative parathyroid identification, and protection, lymph node metastasis, etc, were retrospectively analyzed. All patients were followed up for more than 1 year, and the recovery time of the parathyroid gland was recorded. The independent risk factors for HP recovery were determined by multivariate regression analysis. Results: In 121 cases of total thyroidectomy for thyroid cancer, 34 cases (28.1%) of HP occurred after surgery. The average age was 10.34 ± 3.01. Twenty-five cases of pattern of parathyroid hormone (PTH; 73.5%) recovered within half a year after surgery, 2 cases (5.9%) recovered after 1 year, and 2 cases (5.9%) were still not recovered after 2 years of follow-up. Univariate analysis suggested that PTH ≤ 1 on the first day after surgery and bilateral VI region lymph node metastasis were risk factors affecting the recovery of HP (P < .05). Multivariate regression analysis showed that PTH≤1 on the first day after surgery was an independent risk factor for HP recovery (OR = 0.092, 95% CI: 0.009-0.966, P = .047). Conclusion: Bilateral central lymph node metastasis and PTH ≤ 1 on the first day after surgery were the risk factors for HP recovery. In addition, HP may still recover more than 6 months after surgery, so the timing of diagnosis of permanent HP still needed to be discussed.
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