Postoperative Hypoparathyroidism After Total Thyroidectomy in Children

Zobel, Michael J.; Long, Roger K.; Gosnell, Jessica E.; Sosa, Julie Ann; Padilla, Benjamin E.

doi:10.1016/j.jss.2020.02.018

Cited by 28 publications

(36 citation statements)

References 21 publications

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“…The remaining 13 studies did not report whether thyroidectomies were performed by a low- or a high-volume surgeon [12, 16-20, 22, 24-26, 28, 30]. In 3 studies, thyroidectomies were performed by a pediatric surgeon [14, 21, 22], in 3 studies by an endocrine surgeon [11, 26, 29], and in 4 by both pediatric and adult surgeons [12, 18, 19, 31]. In the other studies, the surgeon’s background was not specified.…”

Section: Resultsmentioning

confidence: 99%

“…De Jong et al [20] reported both hypocalcemia at 24 h after thyroidectomy (48.1%) and hypoparathyroidism on discharge (46.2%; n = 24 out of 52). Zobel et al [19] ( n = 38) reported hypocalcemia immediately after surgery in 17 GD patients, with only 1 patient still being hypocalcemic after 6 months. This patient regained normal parathyroid function 1 year after surgery.…”

Section: Resultsmentioning

confidence: 99%

“…The studies by Cohen et al [23] and de Jong et al [20] reported relatively high frequencies of permanent hypocalcemia of 20 and 17.4%, respectively. The other 20 studies reported (very) low frequencies of permanent hypocalcemia, with 13 studies reporting no cases of permanent hypocalcemia [10, 12, 14-17, 19, 22, 24-27, 29]. In these 20 studies, 1,342 patients were evaluated, and only 21 of them (1.6%) fulfilled the used criteria for permanent hypocalcemia.…”

Section: Resultsmentioning

confidence: 99%

“…In 10 studies, the diagnosis of hypocalcemia was solely based on serum calcium levels [10-12, 15, 18, 20-23, 29]. In contrast, in some studies, the presence of clinical symptoms (hand paresthesia, perioral numbness, muscle cramps, and Chvostek’s sign) was combined with serum calcium levels to diagnose postoperative hypocalcemia [14, 19, 26]. Elfenbein et al [31] diagnosed hypocalcemia solely based on the presence of clinical symptoms (numbness or tingling of the hands, feet, or mouth after surgery) that improved after calcium supplementation.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of the studied patients were female (Table 1). Thirteen studies focused mainly on total or near-total thyroidectomy (n = 705) [10,11,[13][14][15][16][17][18][19][20][21][22][23]. In addition, Lobe and Wright [24] reported results in pediatric patients who underwent total thyroidectomy via a transaxillary endoscopic approach (n = 31).…”

Section: Study Characteristicsmentioning

confidence: 99%

See 4 more Smart Citations

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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

See 3 more Smart Citations

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

Zaat¹,

Derikx²,

Zwaveling-Soonawala³

et al. 2020

Eur Thyroid J

View full text Add to dashboard Cite

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Incidental Parathyroidectomy Among Pediatric Patients Undergoing Thyroid Surgery

et al. 2022

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Objective To evaluate rates of incidental parathyroidectomy(IP) and to determine risk factors among children undergoing thyroid surgery. Study Design Retrospective case‐control study. Methods Pediatric patients undergoing thyroidectomy with or without neck dissection were included in this retrospective cohort study over a 20 year period. Demographics, clinical features, and surgical outcomes were evaluated. The primary outcome was the presence of parathyroid tissue in the surgical specimen. Results Two hundred and eighty‐six patients were included (100 cases with ≥1 parathyroid gland found in the pathology specimen and 186 controls). The most common surgical indication was cancer (49%), followed by benign nodule (25%). Hemithyroidectomy was performed in 119 (42%) patients, total thyroidectomy in 138 (48%), and completion in 29 (10%). Central neck dissection (CND) and lateral neck dissection were performed in 41% and 13%, respectively. 27 (9%) patients had parathyroid reimplantation. On univariable analysis, diagnosis, adenopathy on preoperative ultrasound, extent of thyroidectomy, neck dissection, and parathyroid reimplantation were significant predictors of IP. On multivariate analysis, CND > 5 nodes were the sole predictor of IP. Patients with IP were more likely to require postoperative calcium/vitamin D supplementation compared to those without (44% vs. 16%; P < .001). Conclusions Incidental parathyroidectomy during pediatric thyroidectomy is relatively common. CND was independently predictive of IP. There were increased rates of postoperative hypocalcemia when 1 or more parathyroid gland was identified in the specimen. Reimplantation of 1 parathyroid gland was predictive of another gland in the specimen. Anticipating outcomes may help optimize patient care by allowing for early supplementation, frequent monitoring, and consideration of ancillary monitoring modalities in high‐risk procedures. Level of Evidence Level 4 Laryngoscope, 132:2262–2269, 2022

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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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Postoperative Hypoparathyroidism After Total Thyroidectomy in Children

Cited by 28 publications

References 21 publications

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

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

Incidental Parathyroidectomy Among Pediatric Patients Undergoing Thyroid Surgery

Factors associated with postoperative hypocalcemia following thyroidectomy in childhood

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