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J Pediatr Surg. 2019 Jul 19. pii: S0022-3468(19)30463-4. doi: 10.1016/j.jpedsurg.2019.06.027. [Epub ahead of print]

Children are at a High Risk of Hypocalcaemia and Hypoparathyroidism after Total Thyroidectomy.

Author information

1
Centre for Endocrine Surgery, University College London Hospital and Great Ormond Street Hospital, London, United Kingdom. Electronic address: mechteld.dejong@nhs.net.
2
Centre for Endocrine Surgery, University College London Hospital and Great Ormond Street Hospital, London, United Kingdom.
3
Department of Paediatric Endocrinology, University College London Hospital and Great Ormond Street Hospital, London, United Kingdom.
4
Department of Paediatric Ears, Nose and Throat Surgery, Great Ormond Street Hospital, London, United Kingdom.

Abstract

PURPOSE:

Disruption of calcium homeostasis is the most common complication after total thyroidectomy in adults. We explored the incidence and risk factors of hypocalcaemia and hypoparathyroidism after total thyroidectomy in children (≤18 years of age).

METHODS:

One hundred six children underwent total thyroidectomy. Patient, operative and outcome data were collected and analyzed.

RESULTS:

The indication for surgery was Graves' disease in 52 children (49.1%), Multiple Endocrine Neoplasia type-2 in 36 (33.9%), multinodular goiter in 3 (2.8%) and follicular/papillary thyroid carcinoma in 15 (14.2%). Neck dissection was performed in 23 children (18.9%). In 14 children (13.2%), autotransplantation was performed; in 31 (29.2%), ≥1 glands were found in the specimen. Hypocalcaemia within 24 h of thyroidectomy was observed in 63 children (59.4%) and 52 (49.3%) were discharged on supplements. Hypoparathyroidism at 6 months persisted in 23 children (21.7%). The ratios of all forms of calcium-related-morbidity were larger among children with less than four parathyroid glands remaining in situ: hypocalcaemia within 24 h of thyroidectomy (54.0% versus 47.5%; p = 0.01), hypoparathyroidism on discharge (64.4% versus 37.7%; p = 0.004) and long-term hypoparathyroidism (31.1% versus 14.8%; p = 0.04).

CONCLUSION:

The incidence of postoperative hypocalcaemia and hypoparathyroidism among children undergoing total thyroidectomy is considerable. The inability to preserve the parathyroid glands in situ during surgery seems an important factor. For optimal outcomes, the parathyroid glands should be preserved in situ.

TYPE OF STUDY:

Prognosis Study.

LEVEL OF EVIDENCE:

Level IV.

KEYWORDS:

Hypocalcemia; Hypoparathyroidism; Pediatric population; Total thyroidectomy

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