Children are at a high risk of hypocalcaemia and hypoparathyroidism after total thyroidectomy.

Published on Jul 1, 2020in Journal of Pediatric Surgery2.545
· DOI :10.1016/J.JPEDSURG.2019.06.027
Mechteld C de Jong1
Estimated H-index: 1
(UCLH: University College Hospital),
Hassan Nounou1
Estimated H-index: 1
(UCLH: University College Hospital)
+ 5 AuthorsTom R. Kurzawinski11
Estimated H-index: 11
(UCLH: University College Hospital)
Sources
Abstract
Abstract Purpose Disruption of calcium homeostasis is the most common complication after total thyroidectomy in adults. We explored the incidence and risk factors of hypocalcaemia and hypoparathyroidism after total thyroidectomy in children(≤ 18 years of age). Methods One-hundred-and-six children underwent a total thyroidectomy. Patient, operative and outcome data were collected and analyzed. Results The indication for surgery was Graves' disease in 52 children(49.1%), Multiple Endocrine Neoplasia type-2 in 36(33.9%), multinodular goiter in 3(2.8%) and follicular/papillary thyroid carcinoma in 15(14.2%). Neck dissection was performed in 23 children(18.9%). In 14 children(13.2%), autotransplantation was performed; in 31(29.2%), ≥ 1 glands were found in the specimen. Hypocalcaemia within 24 h of thyroidectomy was observed in 63 children(59.4%) and 52(49.3%) were discharged on supplements. Hypoparathyroidism at six months persisted in 23 children(21.7%). The ratios of all forms of calcium-related-morbidity were larger among children with less than four parathyroid glands remaining in situ : hypocalcaemia within 24 h of thyroidectomy (54.0% versus 47.5%; p  = 0.01), hypoparathyroidism on discharge(64.4% versus 37.7%; p  = 0.004) and long-term hypoparathyroidism(31.1% versus 14.8%; p  = 0.04). Conclusion The incidence of postoperative hypocalcaemia and hypoparathyroidism among children undergoing a total thyroidectomy is considerable. The inability to preserve the parathyroid glands in situ during surgery seems an important factor. For optimal outcomes, the parathyroid glands should be preserved in situ . Type of Study: Prognosis Study. Level of evidence: Level IV.
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References37
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#5Tom R. Kurzawinski (GOSH: Great Ormond Street Hospital)H-Index: 11
BACKGROUND: In patients with multiple endocrine neoplasia type 2 (MEN2) syndrome, genetic testing offers early diagnosis, stratifies the risk of developing medullary thyroid cancer (MTC) and informs the timing of thyroidectomy. The efficacy of treatment, which depends on timely and safe surgery, is not well established. METHODS: This was a retrospective review of diagnostic and clinicopathological outcomes of prophylactic thyroidectomy in children with MEN2 between 1995 and 2013 in the UK. Ameri...
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#1Claudius Falch (University of Tübingen)H-Index: 9
#2Jan Hornig (University of Tübingen)H-Index: 1
Last. Sven Muller (University of Tübingen)H-Index: 9
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Abstract Background Hypocalcemia after total thyroidectomy is the most frequent complication resulting in prolongation of hospitalisation. Therefore we aimed to analyse clinical risk factors predictive for hypocalcemia and its long term persistence after total thyroidectomy. Methods Retrospective analysis of patients undergoing total thyroidectomy from 2005 until 2013. Outcome measures were initial postoperative hypocalcemia defined as serum calcium below 2.0 mmol/l after total thyroidectomy wit...
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#1Han Luo (Sichuan University)H-Index: 9
#2Wanjun Zhao (Sichuan University)H-Index: 9
Last. Jingqiang Zhu (Sichuan University)H-Index: 18
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Background and Objectives. Parathyroid failure is the most common symptom after thyroidectomy. To prevent it, a gland was preserved in situ or an ischemic one was autotransplanted. This study explored the relationship between in situ preservation of the parathyroid gland and gland failure. Methods. Consecutive patients who underwent initial total thyroidectomy were enrolled retrospectively in a prospectively maintained database. Patients were divided into groups by parathyroid gland remaining in...
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#1Inés Villarroya-Marquina (Autonomous University of Barcelona)H-Index: 2
#2Juan J. Sancho (Autonomous University of Barcelona)H-Index: 21
Last. Antonio Sitges-Serra (Autonomous University of Barcelona)H-Index: 42
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OBJECTIVE: Hypocalcaemia is the most common adverse effect after total thyroidectomy. It recovers in about two-thirds of the patients within the first postoperative month. Little is known, however, about recovery of the parathyroid function (RPF) after this time period. The aim of the present study was to investigate the time to RPF in patients with protracted (>1 month) hypoparathyroidism after total thyroidectomy. DESIGN: Cohort prospective observational study. METHODS: Adult patients undergoi...
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#1Gabrielle Hicks (USYD: University of Sydney)H-Index: 1
#2Robert George (USYD: University of Sydney)H-Index: 4
Last. Mark Sywak (USYD: University of Sydney)H-Index: 51
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The most common complication of total thyroidectomy is parathyroid insufficiency. Acute, transient, post-operative hypoparathyroidism increases length of hospitalization, morbidity and cost associated with total thyroidectomy. While permanent hypoparathyroidism poses a significant medical burden with lifetime medication, regular follow up and considerable disease burden related to chronic renal failure and other sequelae. Parathyroid autotransplantation has been demonstrated to result in biochem...
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#1Ioannis Christakis (Churchill Hospital)H-Index: 15
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Background: Inadvertent parathyroidectomy (IP) during thyroid operations is a recognised phenomenon. We evaluated the incidence of IP during thyroid operations in a large case-series and identified the risk factors involved. Methods: Retrospective review of all thyroidectomy operations [total thyroidectomies (TT) and near-total thyroidectomies (NTT)] performed in a single institution from January 2004 to January 2009. We excluded re-operative cases, combined thyroid and parathyroid pathology, he...
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#1D. M. McGoldrick (Cork University Hospital)H-Index: 2
#2M Majeed (Cork University Hospital)H-Index: 2
Last. Henry Paul Redmond (Cork University Hospital)H-Index: 59
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Introduction Inadvertent parathyroidectomy is a recognised complication of thyroid surgery. We aimed to investigate the incidence of and risk factors for inadvertent parathyroidectomy during thyroid surgery, in our patient cohort.
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Context: Adults with hypoparathyroidism have significant rates of nephrocalcinosis and impaired renal function. Little is known about the impact of hypoparathyroidism treatment on renal function in children. Objectives: To determine the prevalence and predictors for renal abnormalities (nephrocalcinosis and decreased estimated glomerular filtration rate [eGFR]) in children with treated hypoparathyroidism. Design and Setting: A retrospective chart review of patients with permanent hypoparathyroid...
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#1Yufei Chen (Harvard University)H-Index: 11
#2Peter T. Masiakos (Harvard University)H-Index: 23
Last. Antonia E. Stephen (Harvard University)H-Index: 28
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Abstract Introduction Hypocalcemia is a common complication following thyroid surgery. We seek to report on our experience in pediatric thyroidectomy in a high volume thyroid surgery center and accurately assess the incidence of postoperative hypocalcemia. Materials and methods A retrospective review of patients aged 18 and younger who underwent thyroid surgery between 1992 and 2013. The primary endpoints were the occurrence of postoperative hypocalcemia as by defined as a nadir calcium Results ...
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#1Leyre Lorente-Poch (Autonomous University of Barcelona)H-Index: 10
#2Juan J. Sancho (Autonomous University of Barcelona)H-Index: 21
Last. Antonio Sitges-Serra (Autonomous University of Barcelona)H-Index: 42
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Background Parathyroid failure is the most common complication after total thyroidectomy but factors involved are not completely understood. Accidental parathyroidectomy and parathyroid autotransplantation resulting in fewer than four parathyroid glands remaining in situ, and intensity of medical treatment of postoperative hypocalcaemia may have relevant roles. The aim of this study was to determine the relationship between the number of parathyroid glands remaining in situ and parathyroid failu...
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Multiple Endocrine Neoplasia 2 (MEN2) is a hereditary cancer syndrome for developing medullary thyroid cancer (MTC) due to germline mutations of RET gene. Subjects harboring a germline RET mutation without any clinical signs of MTC are defined as gene carriers (GCs), for whom guidelines propose a prophylactic thyroid surgery. We evaluate if active surveillance of GCs, pursuing early thyroid surgery, can be safely proposed and if it allows safely delaying thyroid surgery in children until adolesc...
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#1Jesse J. van Rooijen (UvA: University of Amsterdam)
#2A S Paul van Trotsenburg (UvA: University of Amsterdam)H-Index: 24
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Background: Thyroidectomy 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. Objective: To 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. Methods: A retrospective single ...
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INTRODUCTION Hypoparathyroidism (HP) is the most common complication of total thyroidectomy and can be an emergency. OBJECTIVES To describe the prevalence of HP after total thyroidectomy in children under 14 years of age, the variables related to its appearance and its clinical expression. PATIENTS AND METHODS Retrospective study at a children's hospital in the last 20 years. HP was defined by the need to supplement calcium after the intervention and was considered permanent if it could not be s...
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#1Kung-Ting Kao (Royal Children's Hospital)H-Index: 1
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OBJECTIVES Post-thyroidectomy hypocalcemia is a common complication that causes increased morbidity. This review aims to identify the factors that predict occurrence of hypocalcemia after total thyroidectomy in children and adolescents. METHODS Comprehensive searches of English language pediatric (≤18 years of age) articles were performed in Medline, CINAHL, EMBASE, Web of Science and the Cochrane Library. Studies published between January 1, 1970 to August 20, 2020 regarding risk factors and st...
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#1Georgios D. Koimtzis (Cardiff and Vale University Health Board)H-Index: 1
#2Leandros Stefanopoulos (A.U.Th.: Aristotle University of Thessaloniki)H-Index: 4
Last. Theodosios Papavramidis (A.U.Th.: Aristotle University of Thessaloniki)H-Index: 6
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INTRODUCTION Post-operative hypoparathyroidism is the most encountered complication of thyroid surgery and is classified as temporary or permanent. However, its incidence varies greatly in the literature ranging from 0.5% to 65%. This can be mainly attributed to the different definition of hypoparathyroidism used in each study and especially to the different time cutoff applied to distinguish temporary from permanent hypoparathyroidism. METHODS We conducted a systematic literature search in PubM...
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#3Elwira Szychot (GOSH: Great Ormond Street Hospital)H-Index: 4
AIM Differentiated thyroid cancer (DTC) in children and adolescents is rare and data about its presentation and management are not well known. The aim of this study was to provide evidence of the current practice in the United Kingdom before the launch of the Rare National Paediatric Endocrine Tumours Guidelines (to be published in 2020). METHODS Seventy-two children and adolescents with DTC (<18 years) who were treated at our institution between 2003 and 2018 were identified and their presentat...
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#1Ankitha Radakrishnan (NU: Northwestern University)H-Index: 3
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Abstract Introduction Hypocalcemia is the most common complication following thyroidectomy in children. Guidelines to manage post-thyroidectomy hypocalcemia are available for adults, but not children. The objective of this review was to identify practices related to hypocalcemia prevention and management in pediatric patients. Methods We identified studies examining the prevention and management of hypocalcemia in pediatric patients post-thyroidectomy within PubMed, EMBASE, Web of Science and Co...
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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...
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