Rate of Incidental Parathyroidectomy in a Pediatric Population

Abstract

Objective Incidental parathyroidectomy is a relatively common occurrence in thyroid surgery, which may lead to hypoparathyroidism and postoperative hypocalcemia, but it is not well studied in children. The objectives of this study were to determine the rate of incidental parathyroidectomy, identify potential risk factors, and investigate postoperative complications in children undergoing thyroidectomy. Study Design Retrospective cohort study. Setting Patients who underwent thyroidectomy over a 10-year period at a tertiary children’s hospital. Methods Pathology reports were reviewed to determine incidental parathyroid gland tissue. Additional data collected included patient demographics, type of procedure, underlying thyroid pathology, as well as immediate and long-term postoperative clinical outcomes. Results Of 209 patients, 65 (31%) had incidental parathyroidectomy. Several variables were associated with incidental parathyroidectomy on univariable analysis. However, in the final multivariable model, only thyroidectomy with lymph node dissection was associated with increased odds of having incidental parathyroidectomy (odds ratio, 3.3; P = .04; 95% CI, 1.1-9.8). After a median follow up of 1 year, a significantly higher percentage of patients with incidental parathyroidectomy had evidence of long-term hypoparathyroidism (9/62 [15%] vs 3/144 [2%], P = .001). Conclusion Incidental parathyroidectomy was relatively common in our pediatric thyroidectomy population, which may be a result of several anatomic, clinical, and surgeon-related factors. Close attention to parathyroid preservation with meticulous surgical technique is the most practical method of preventing long-term hypoparathyroidism and hypocalcemia.

Thyroid Surgery in Children: A 5-Year Retrospective Study at a Single Paediatric Surgical Center and Systematic Review

“…The few complications that were reported are in accordance with the literature findings [ 3 , 13 , 16 , 18 , 19 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Infection of the wound is well-known and possible complications occur after every surgical procedure.…”

“…A literature review of eighteen articles dealing with thyroid surgery in paediatric population is shown in Table 3 [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Most studies (18) included in our literature review were retrospective studies.…”

“…Study period varied from 1 year [ 17 ] to 18 years [ 22 ]. Studies with the most patients were those in which partial or total thyroidectomy was usually performed [ 12 , 13 , 15 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ], while fewer patients were included in studies that analysed robotic trans-axillary and retro-auricular approach [ 14 ] or transoral endoscopic thyroidectomy via vestibular approach [ 17 ]. The most common complication in all operations was hypocalcaemia due to incidental parathyroidectomy and recurrent laryngeal nerve injury.…”

“…In our case, this was resolved with antibiotic treatment and regular dressings. Manifest hypocalcemia is one of the most frequent postoperative complications after thyroid surgery [ 13 , 29 ]. Transient, mild hypocalcemia is reported in from 15% to 30% of patients [ 10 ].…”

“…This is reported in from 1% to 7% of patients after thyroid surgery [ 10 ]. It is well-known that hypocalcemia is the result of extraction or vascular damage to parathyroid glands [ 13 ]. Recent findings reveal that near-infrared fluorescent imaging could help visualize parathyroid glands, and thus decrease the rate of the parathyroid damage and consequently patient’s hypocalcemia [ 10 , 33 , 34 ].…”