Pediatric Increased Risk and Nonlinear Age-Dependent Risk of Hypoparathyroidism After Total Thyroidectomy: A...

Post-thyroidectomy hypoparathyroidism is the most common complication of total thyroidectomy and a key indicator of surgical quality. The influence of age on postoperative risk, across the spectrum from pediatric to adult patients, remains incompletely defined.

Retrospective cohort study of 1914 consecutive patients undergoing primary total thyroidectomy for Graves' disease or differentiated thyroid carcinoma at a high-volume center, comprising 87 pediatric (< 18 years) and 1827 adult (≥ 18 years) patients operated on by the same endocrine surgical team. Transient and permanent hypoparathyroidism were defined according to the 2025 ESES/AAES/IAES consensus, with permanent disease confirmed biochemically beyond 12 months. Multivariable models were adjusted for surgical indication and lymph node dissection; within adults, age was modeled with restricted cubic splines followed by an age-band analysis. Pediatric histopathology was reviewed for inadvertent parathyroid excision.

Transient hypoparathyroidism occurred in 29.9% of pediatric and 17.2% of adult patients (P = 0.004) and permanent hypoparathyroidism in 3.4% and 0.4% (P = 0.011). After adjustment, pediatric age remained independently associated with transient (OR 1.86, 95% CI 1.15-3.01) and permanent hypoparathyroidism (OR 5.74, 95% CI 1.35-20.02). Other surgical complications did not differ between groups. Inadvertent parathyroid excision was uncommon and accounted for only 1 pediatric hypoparathyroidism case, implicating devascularization rather than gland removal. Among adults, age showed a non-linear association with transient hypoparathyroidism, with increased risk at 40-50 years (OR 1.50, 95% CI 1.15-1.96; P = 0.003), particularly in differentiated thyroid carcinoma.

Pediatric patients undergoing primary total thyroidectomy are at increased risk of postoperative hypoparathyroidism independent of surgical indication and extent, even under uniform high-volume surgical conditions, with devascularization the likely mechanism. In adults, risk varies non-linearly with age. These findings support age as a determinant of postoperative endocrine outcomes.