Potential determinants and predictors of hypoparathyroidism after total thyroidectomy in pediatric patients

Objective

Few studies have reported risk factors for post-thyroidectomy hypoparathyroidism (HPT) in children. We aimed to identify predicting factors for transient and permanent HPT after total thyroidectomy in pediatric patients.

Study design

Retrospective review of medical charts.

Setting

A tertiary university-affiliated medical center.

Methods

A retrospective study of all children who underwent thyroid surgery between 2001 and 2019.

Results

The study included 70 patients. Sixteen patients (23%) had postoperative HPT: 10 transient (14%) and 6 permanent (9%). Central compartment neck dissection, larger nodular size, malignant disease, and extrathyroidal extension (ETE) were associated with overall HPT. ETE (p = 0.034) and younger age at diagnosis (median 10.5 vs. 14.5 years, p = 0.035) were associated with permanent HPT. Several calcium indices were associated with permanent HPT, including first calcium level, minimal calcium level, and the decrease in calcium level after surgery.

Conclusions

Patients under 10.5 years of age and those presenting with ETE are at potential risk of developing permanent HPT after total thyroidectomy. Postoperative calcium levels may have a role as a predictor of permanent HPT and should be considered in the decision on calcium monitoring and supplementation.