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Published on: July 14, 2023
Potential determinants and predictors of hypoparathyroidism after total thyroidectomy in pediatric patients
Amit Ritter1,2, Yonatan Reuven3,4, Nir Tsur3,4
1Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, 49100, Israel. amit.ritter@gmail.com.
Insights
Younger children and those with extrathyroidal extension (ETE) face higher risks of permanent hypoparathyroidism after thyroid surgery. Postoperative calcium levels can predict this complication.
Area of Science:
- Pediatric Surgery
- Endocrinology
- Oncology
Background:
- Post-thyroidectomy hypoparathyroidism (HPT) is a known complication.
- Risk factors for HPT in pediatric patients undergoing total thyroidectomy are not well-established.
Purpose of the Study:
- To identify predictors of transient and permanent HPT in children following total thyroidectomy.
Main Methods:
- Retrospective chart review of pediatric patients who underwent thyroid surgery between 2001 and 2019 at a tertiary medical center.
- Analysis of patient demographics, surgical factors, and postoperative calcium levels.
Main Results:
- Of 70 patients, 16% developed HPT (14% transient, 9% permanent).
- Factors associated with overall HPT included central compartment neck dissection, larger nodule size, malignancy, and extrathyroidal extension (ETE).
- Permanent HPT was linked to ETE and younger age (median 10.5 years). Postoperative calcium levels also showed predictive value.
Conclusions:
- Younger age (<10.5 years) and ETE are risk factors for permanent HPT after pediatric total thyroidectomy.
- Postoperative calcium monitoring is crucial for predicting and managing permanent HPT.
Objective:
Few studies have reported risk factors for post-thyroidectomy hypoparathyroidism (HPT) in children. We aimed to identify predicting factors for transient and permanent HPT after total thyroidectomy in pediatric patients.
Study Design:
Retrospective review of medical charts.
Setting:
A tertiary university-affiliated medical center.
Methods:
A retrospective study of all children who underwent thyroid surgery between 2001 and 2019.
Results:
The study included 70 patients. Sixteen patients (23%) had postoperative HPT: 10 transient (14%) and 6 permanent (9%). Central compartment neck dissection, larger nodular size, malignant disease, and extrathyroidal extension (ETE) were associated with overall HPT. ETE (p = 0.034) and younger age at diagnosis (median 10.5 vs. 14.5 years, p = 0.035) were associated with permanent HPT. Several calcium indices were associated with permanent HPT, including first calcium level, minimal calcium level, and the decrease in calcium level after surgery.
Conclusions:
Patients under 10.5 years of age and those presenting with ETE are at potential risk of developing permanent HPT after total thyroidectomy. Postoperative calcium levels may have a role as a predictor of permanent HPT and should be considered in the decision on calcium monitoring and supplementation.
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