Pediatric thyroidectomy in a high volume thyroid surgery center: Risk factors for postoperative hypocalcemia

Yufei Chen; Peter T Masiakos; Randall D Gaz; Richard A Hodin; Sareh Parangi; Gregory W Randolph; Peter M Sadow; Antonia E Stephen

doi:10.1016/j.jpedsurg.2014.10.056

Pediatric thyroidectomy in a high volume thyroid surgery center: Risk factors for postoperative hypocalcemia

J Pediatr Surg. 2015 Aug;50(8):1316-9. doi: 10.1016/j.jpedsurg.2014.10.056. Epub 2014 Nov 5.

Authors

Yufei Chen¹, Peter T Masiakos², Randall D Gaz³, Richard A Hodin⁴, Sareh Parangi⁵, Gregory W Randolph⁶, Peter M Sadow⁷, Antonia E Stephen⁸

Affiliations

¹ Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: [email protected].
² Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: [email protected].
³ Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: [email protected].
⁴ Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: [email protected].
⁵ Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: [email protected].
⁶ Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA. Electronic address: [email protected].
⁷ Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: [email protected].
⁸ Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: [email protected].

PMID: 25783304
DOI: 10.1016/j.jpedsurg.2014.10.056

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 <8.0mg/dL and being discharged on oral calcium supplementation, need for intravenous calcium and the occurrence of permanent hypoparathyroidism.

Results: 171 patients who underwent 186 thyroid operations were analyzed. The average age was 15.4years with 82.3% female. The most common indications for surgery were nodular disease (74.7%) and hyperthyroidism (12.4%). 24 patients (12.9%) experienced postoperative hypocalcemia with 13 (7.0%) requiring intravenous calcium infusion. One patient (0.9%) experienced permanent hypoparathyroidism. Risk factors for postoperative hypocalcemia included total thyroidectomy (OR 7.39, p<0.01), central and bilateral lateral neck dissection (OR 22.26, p=0.01), Graves' disease (OR 3.99, p=0.02), and malignancy (OR 2.96, p=0.03).

Conclusions: Pediatric patients who undergo total thyroidectomy for underlying malignancy or Graves' disease and those who have more extensive nodal dissections are at increased risk of developing this postoperative hypocalcemia. These patients may benefit from more vigilant preoperative preparation and postoperative calcium and vitamin D supplementation.

Keywords: Endocrine; Hypocalcemia; Pediatric; Thyroidectomy.

Publication types

Evaluation Study

MeSH terms

Adolescent
Child
Child, Preschool
Female
Hospitals, High-Volume
Humans
Hypocalcemia / epidemiology
Hypocalcemia / etiology*
Hypoparathyroidism / epidemiology
Hypoparathyroidism / etiology
Incidence
Male
Postoperative Complications / epidemiology
Postoperative Complications / etiology*
Retrospective Studies
Risk Factors
Surgicenters
Thyroid Diseases / surgery*
Thyroidectomy*
Treatment Outcome