Disease impacts more than age on operative morbidity in children with Graves’ disease after total thyroidectomy

Machens, Andreas; Elwerr, Malik; Schneider, Rick; Lorenz, Kerstin; Dralle, Henning

doi:10.1016/j.surg.2018.07.021

Cited by 17 publications

(32 citation statements)

References 20 publications

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“…Yet, permanent hypoparathyroidism was observed only in 1.9%, even though cases of intentional parathyroidectomy for locally advanced thyroid carcinoma were not excluded from analysis. Comparably low rates of permanent hypoparathyroidism were also reported by other specialized centers [31,32,38]. Transient hypoparathyroidism was observed in 33.6% of bilateral thyroid operations in the present analysis but recovered in the vast majority of cases (1.9% permanent hypoparathyroidism).…”

Section: Discussionsupporting

confidence: 76%

“…In the present study, an underlying restoration period following parathyroid autotransplantation appears plausible for this observation. In the literature, children with the diagnosis of Graves' disease were shown to harbor a higher risk for transient hypoparathyroidism [38]. This study illustrates, that the risk of transient hypoparathyroidism in group I, consisting to 77.8% of cases with therapy refractory Graves' disease, was similar as in group II, which included operations for preoperatively suspected/verified malignant diagnoses (Fig.…”

Section: Discussionsupporting

confidence: 67%

“…Bethesda category V ("suspicious for malignancy") was diagnosed in 16.7% (7), and Bethesda category IV ("suspicious for follicular neoplasm") and Bethesda category VI ("malignancy") were diagnosed in equally 9.5% (4). Independent from the cytological result, a molecular assessment of BRAFV600E mutation, as a highly sensitive indicator of the presence of papillary thyroid carcinoma [29], was conducted for 90.5% of FNAC aspirates (38). 10.5% of analyzed cases harbored BRAFV600E mutation.…”

Section: Resultsmentioning

confidence: 99%

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Thyroid surgery in children and young adults: potential overtreatment and complications

Staubitz

Bode

Poplawski

et al. 2020

Langenbecks Arch Surg

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Purpose Thyroid nodules in the pediatric population are more frequently associated with malignant thyroid disease than in adult cohorts. Yet, there is a potential risk of surgical overtreatment. With this single center study, an analysis of potential overtreatment for suspected malignant thyroid disease in children and young adults was aimed for. Methods In a period from 2005 to 2018, 155 thyroid operations in children and young adults performed at the University Medical Center Mainz, Germany, were analyzed (patient age 3-20 years, 117 female). Cases were categorized for preoperative diagnosis: non-malignant (group I, n = 45) and malignant thyroid disease (group II, n = 110). Postoperative parameters (histology, complication rates) were assessed and compared between groups. Results 91.1% of group I were histologically benign. 44.5% of group II harbored malignancy. Permanent hypoparathyroidism was documented in group I (2.7%) and in group II (1.4%, p = 1.000). Wound infections were absent in group I but observed in group II (0.9%, p = 1.000). Transient vocal cord palsy was recorded only in group I (2.3%, 2/85 vs. 0/177 nerves at risk, p = 0.104). Permanent vocal cord palsies were absent. Conclusion Preoperative diagnoses were correct in over 90% of group I and in nearly 45% of group II. The high proportion of carcinomas in group II ruled out the issue of potential overtreatment. The risk of severe postoperative complications was equally low in both patient groups.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionsupporting

confidence: 67%

Section: Resultsmentioning

confidence: 99%

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Thyroid surgery in children and young adults: potential overtreatment and complications

Staubitz

Bode

Poplawski

et al. 2020

Langenbecks Arch Surg

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“…Table 1 also shows in which studies thyroidectomies were performed by a high-volume or a low-volume surgeon. Eight studies reported that the thyroidectomy was performed by a high-volume surgeon [10, 11, 13-15, 21, 29, 31]. In the study by Cohen et al [23], surgery was performed by a low-volume surgeon.…”

Section: Resultsmentioning

confidence: 99%

“…Sugino et al [26] reported all patients to be euthyroid at the time of surgery, without reporting the used preoperative treatment protocol. The other included studies did not report on preoperative preparation or preoperative thyroid hormone levels in their patients [10, 13, 15, 17-22, 24, 25, 28-31]. Further characteristics of the included studies are shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Thyroidectomy in Pediatric Patients with Graves’ Disease: A Systematic Review of Postoperative Morbidity

Zaat¹,

Derikx²,

Zwaveling-Soonawala³

et al. 2020

Eur Thyroid J

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Background: Graves’ disease (GD) is the most common cause of hyperthyroidism. In children, the overall relapse frequency after treatment with antithyroid drugs is high. Therefore, many pediatric GD patients eventually require thyroidectomy as definitive treatment. However, the postoperative complications of thyroidectomy in pediatric GD patients are poorly reported. Objective: To identify the frequency of short- and long-term postoperative morbidities after thyroidectomy in pediatric GD patients. Methods: A systematic review of the literature (PubMed and Embase) was performed to identify studies reporting short- and long-term postoperative morbidities after thyroidectomy in pediatric GD patients according to the PRISMA guidelines. Results: Twenty-two mainly retrospective cohort studies were included in this review evaluating short- and long-term morbidities in 1,424 children and adolescents. The frequency of transient hypocalcemia was 22.2% (269/1,210), with a range of 5.0–50.0%. The frequency of permanent hypocalcemia was 2.5% (36/1,424), with a range of 0–20.0%. Two studies reported high frequencies of permanent hypocalcemia, 20.0 (6/30) and 17.4% (9/52), respectively. The 20% frequency could be explained by low-volume surgeons in poorly controlled GD patients. Only 21 cases of permanent hypocalcemia were reported in the 1,342 patients included in the other 20 studies (1.6%). Transient and permanent recurrent laryngeal nerve injury were reported less frequently, with frequencies between 0–20.0 and 0–7.1%, respectively. Infection, hemorrhage/hematoma, and keloid development were only rarely reported as postoperative complications. Conclusion: The results of this systematic review suggest that thyroidectomy is a safe treatment option for pediatric GD patients. The minority of patients will experience transient and benign morbidities, with hypocalcemia being the most common transient postoperative morbidity. Permanent postoperative morbidities are relatively rare.

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Besondere Aspekte der Schilddrüsenchirurgie bei Kindern

Staubitz¹,

Musholt²

2021

Springer Reference Medizin

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Disease impacts more than age on operative morbidity in children with Graves’ disease after total thyroidectomy

Cited by 17 publications

References 20 publications

Thyroid surgery in children and young adults: potential overtreatment and complications

Thyroid surgery in children and young adults: potential overtreatment and complications

Thyroidectomy in Pediatric Patients with Graves’ Disease: A Systematic Review of Postoperative Morbidity

Besondere Aspekte der Schilddrüsenchirurgie bei Kindern

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