Permanent Hypoparathyroidism After Total Thyroidectomy in Children: Results from a National Registry

Abstract

IntroductionHypoparathyroidism is the most common complication following thyroidectomy. There are few population-based reports on the rate of hypoparathyroidism in children. The incidence of medical treatment of permanent hypoparathyroidism in children is reported using a national registry.MethodsThe study population included patients below 18 years of age undergoing total thyroidectomy reported to the Scandinavian Quality Registry for Thyroid, Parathyroid and Adrenal Surgery 2004–2014. Patients with previous thyroid or parathyroid surgery or treatment with vitamin D before surgery were excluded from analysis. Permanent postoperative hypoparathyroidism was defined as treatment with vitamin D for more than 6 months after thyroidectomy. Risk factors for permanent hypoparathyroidism were calculated with uni- and multivariable logistic regression. Using data from the Swedish Inpatient Registry, rates of readmissions and annual number of days in hospital after total thyroidectomy were compared between patients with and without permanent hypoparathyroidism.ResultsSome 274 children (215 girls and 59 boys) underwent total thyroidectomy. The median age was 14 (range 0–17) years. Indications for surgery were Graves’ disease (214, 78.1%), other benign disease (27, 9.9%) and thyroid cancer (33, 12%). Median follow-up was 4.8 years. Twenty (7.3%) children developed permanent hypoparathyroidism. No statistically significant risk factors for permanent hypoparathyroidism were identified. Rates of readmission and annual number of days in hospital after discharge were similar in patients with and without permanent hypoparathyroidism.ConclusionsThe rate of permanent hypoparathyroidism following total thyroidectomy in children was high and is a cause of concern.

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

“…In children and adolescents, complication rates were shown to be higher than in the adult population, with particularly high complication rates at young age < 6 years [35,36]. An analysis of the Swedish National Registry showed that for total thyroidectomy in children, the rate of permanent hypoparathyroidism reached 7.3% [37]. In the present analysis, median patient age was similar as in the aforementioned study.…”

Causes and pathophysiology of hypoparathyroidism

“…In Denmark the overall prevalence of surgical hypoparathyroidism was 22 per 100,000 inhabitants [15]. In children undergoing neck surgery, the incidence of hypoparathyroidism after neck surgery can be as high as 7.3%, even if the operation has been performed in endocrine surgery referral centers [75].…”

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

“…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.…”

“…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.…”

“…Based on the quality assessment, the quality of 4 of the included studies was rated as good [10][11][12][13], whereas the quality of the other 18 studies was rated as fair (see online suppl. Table 1; for all online suppl.…”