Hypocalcemia prevention and management after thyroidectomy in children: A systematic review

Radakrishnan, Ankitha; Reddy, Abhita T.; Dalal, Prarthana; Rastatter, Jeffrey C.; Josefson, Jami L.; Samis, Jill; Beestrum, Molly; Tian, Yao; Raval, Mehul V.

doi:10.1016/j.jpedsurg.2020.08.032

Cited by 16 publications

(14 citation statements)

References 30 publications

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“…Hypocalcemia is one of the most frequent complications of thyroid surgery, associated with intraoperative ischemia and/or reduction in volume of parathyroid glands or incidental parathyroidectomy 38,39 . To date, few studies have focused on hypocalcemia and the possible predictive factors of this complication following thyroid surgery in children and adolescents 40–43 . In reported case series, TtHP incidence ranges from 13.6% to 34% 44,45 following total thyroidectomy in pediatric age.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with postoperative hypocalcemia following thyroidectomy in childhood

Spinelli

Ghionzoli

Bertocchini

et al. 2022

Pediatric Blood & Cancer

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Background: Postoperative hypocalcemia is a frequent complication after thyroidectomy. Hypoparathyroidism may develop as transient (TtHP), with normalization within six months from surgery, or permanent (PtHP) if the patient requires replacement therapy. We analyzed factors associated with the development of postoperative hypoparathyroidism and in detail PtHP following thyroid surgery in a pediatric population.Procedure: A retrospective multicenter study analyzing 326 patients was carried out.We recorded gender, age, tumor size, thyroiditis, extrathyroidal extension, lymph node dissection (central/lateral compartment, unilateral/bilateral), parathyroid autotransplantation, and histology. Additionally, calcium levels were acquired postoperatively. Results:We analyzed pediatric patients ≤18 years who underwent thyroidectomy clustered into age groups (≤15 or > 15). Patients' mean follow-up was 5.8 years (1-11 years). Postoperative hypoparathyroidism occurred in 36 (11.0%): 20 cases (6.13%) developed PtHP. Postoperative hypoparathyroidism was more frequent in younger patients (P = 0.014), in larger tumors (P < 0.001), in case of extrathyroidal extension (P = 0.037), and in central compartment (P = 0.020) and bilateral lymph node dissection (P = 0.030). PtHP was more frequent in older patients (P = 0.014), in case of thyroiditis (P < 0.001), and extrathyroidal extension (P < 0.001). Concerning the first postoperative calcium level measurement, in the postoperative hypoparathyroidism group, we registered a 8.17 mg/dL value with 14% pre/postoperative decrease (Δ Ca ), whereas in PtHP patient group calcium level was 7.91 mg/dL with 16.7% Δ Ca .

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Section: Discussionmentioning

confidence: 99%

Factors associated with postoperative hypocalcemia following thyroidectomy in childhood

Spinelli

Ghionzoli

Bertocchini

et al. 2022

Pediatric Blood & Cancer

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“…In most cases, postoperative hypocalcemia is caused by hypoparathyroidism due to devascularization or accidental removal of the parathyroid glands (10,12). Permanent hypocalcemia/hypoparathyroidism requires lifelong treatment with calcium and/or active vitamin D (13,14). Almquist et al even reported a twofold increased risk of death in adult patients who developed permanent hypocalcemia due to total thyroidectomy (15).…”

Section: Discussionmentioning

confidence: 99%

“…In most cases, postoperative hypocalcemia is caused by hypoparathyroidism due to devascularization or accidental removal of the parathyroid glands ( 10 , 12 ). Permanent hypocalcemia/hypoparathyroidism requires lifelong treatment with calcium and/or active vitamin D ( 13 , 14 ). Almquist et al.…”

Section: Introductionmentioning

confidence: 99%

Complications After Thyroidectomy in Children: Lymph Node Dissection Is a Risk Factor for Permanent Hypocalcemia

et al. 2021

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BackgroundThyroidectomy is a treatment option in some benign thyroid disorders and the definitive treatment option for thyroid cancer. As postoperative mortality is extremely rare data on postoperative complications and long-term health consequences are important.ObjectiveTo evaluate the frequencies of short- and long-term complications, and their risk factors in pediatric patients (0-18 years) who underwent a thyroidectomy in a tertiary children’s hospital.MethodsA retrospective single center study was performed including all pediatric patients who underwent a thyroidectomy between January 2013 and February 2020.ResultsForty-eight patients were included in this study (mean age 14.6 years). Twenty-nine total thyroidectomies and 19 hemithyroidectomies were conducted. Thyroid carcinoma was the indication to perform a thyroidectomy in 12 patients, 36 patients underwent a thyroidectomy because of a benign thyroid disorder. Postoperative hypocalcemia was evaluated in patients who underwent a total thyroidectomy. Rapidly resolved hypocalcemia was observed in three patients (10.3%), transient hypocalcemia in 10 patients (34.5%) and permanent hypocalcemia in six patients (20.7%). Permanent hypocalcemia was only seen in patients who underwent a thyroidectomy combined with additional lymph node dissection because of thyroid carcinoma [thyroid carcinoma: OR 43.73, 95% CI (2.11-904.95); lymph node dissection: OR 76.14, 95% CI (3.49-458.98)]. Transient and permanent recurrent laryngeal nerve injury was reported in four (8.3%) and one (2.1%) of all patients, respectively.ConclusionPermanent postoperative complications after thyroidectomy are rare in pediatric patients undergoing a thyroidectomy without lymph node dissection. However, in this age group permanent hypocalcemia occurs more frequently after thyroidectomy with additional lymph node dissection because of thyroid cancer. With respect to quality of life, especially of pediatric thyroid cancer patients, reducing this complication is an important goal.

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“…First, according to NHANES 2001−2004 data, about 9% of the pediatric population was vitamin D deficient and 61% in the insufficient range; preoperative cholecalciferol or ergocalciferol have not been shown to reduce hypocalcemia rates in pediatric thyroidectomy patients. 16 , 17 Interestingly, in the article by Tsai et al looking to assess intraoperative PTH and hypocalcemia, they screened their pediatric patients for vitamin D deficiency and treated with D3 replacement or provided 50,000 IU D3 to those with unknown levels. Outcomes showed that initial PTH levels were not related to the vitamin D deficiency status of the patient.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent review article, intravenous calcium therapy was provided to most pediatric patients for hypocalcemia treatment. 17 However, our baseline group only had 10 patients (8%) who received intravenous calcium, mostly for tetany and low calcium levels. Only 4 patients (3%) required intravenous calcium during the quality initiative.…”

Section: Discussionmentioning

confidence: 99%

Unexpected Benefits in Single Institution Experience With Successful Implementation of a Standardized Perioperative Protocol in Pediatric Thyroidectomy

Cossen

Santore

Prickett

et al. 2022

Pediatric Quality &Amp; Safety

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Introduction: To illustrate how quality improvement can produce unexpected positive outcomes. Methods: We compared a retrospective review of perioperative management and outcomes of baseline 122 pediatric total thyroidectomies to 121 subsequent total thyroidectomies managed by an Electronic Medical Record protocol in a large, free-standing children’s healthcare system. Process measures included serum calcium measurement 6−12 hours postoperatively; parathyroid hormone measurement 6 hours postoperatively; preoperative iodine for Graves disease, and postoperative prophylactic calcium carbonate administration. In addition, we completed 4 Plan-Do-Study-Act (PDSA) cycles, focusing on implementation, refinement, usage, education, and postoperative calcitriol administration. The primary outcome included transient hypocalcemia during admission. Results: All perioperative process measures improved over PDSA cycles. Measurement of postoperative serum calcium increased from 42% at baseline to 100%. Measurement of postoperative PTH increased from 11% to 97%. Preoperative iodine administration for Graves disease surgeries improved from 72% to 94%. Postoperative calcium carbonate administration increased from 36% to 100%. There was a trend toward lower rates of severe hypocalcemia during admission over the subsequent PDSA cycles starting at 11.6% and improving to 3.4%. With the regular review of outcomes, surgical volume consolidated among high-volume providers, associated with a decrease in a permanent hypoparathyroid rate of 20.5% at baseline to 10% by the end of monitoring. Conclusions: In standardizing care at 1 large pediatric institution, implementing a focused quality improvement project involving the perioperative management of transient hypocalcemia in total thyroidectomy pediatric patients resulted in additional, unanticipated improvements in patient care.

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Hypocalcemia prevention and management after thyroidectomy in children: A systematic review

Cited by 16 publications

References 30 publications

Factors associated with postoperative hypocalcemia following thyroidectomy in childhood

Factors associated with postoperative hypocalcemia following thyroidectomy in childhood

Complications After Thyroidectomy in Children: Lymph Node Dissection Is a Risk Factor for Permanent Hypocalcemia

Unexpected Benefits in Single Institution Experience With Successful Implementation of a Standardized Perioperative Protocol in Pediatric Thyroidectomy

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