ESPE Yearbook of Paediatric Endocrinology

J Pediatr Surg. 2020 Jul;55(7):1260–1264 Abstract: https://pubmed.ncbi.nlm.nih.gov/31383578/

In brief: Hypoparathyroidism is a common complication after total thyroidectomy and has been reported to occur in 30% to 60% of adult patients. The current study of 106 pediatric patients undergoing total thyroidectomy between 1998–2018 reports that hypoparathyroidism was common, with hypocalcemia occurring during the first 24h in 63 (59%) children and that hypoparathyroidism persisted at 6 months post-surgery in 23 (22%) children.

Comment: The authors report the outcomes in calcium homeostasis in a retrospective chart review of 106 pediatric patients undergoing total thyroidectomy between 1998 and 2018. All children who underwent total thyroidectomy between 1998–2018 at either University College London Hospital or Great Ormond Street Hospital (both London, United Kingdom) and were ≤18 years of age at the time of surgery were included in the analysis. The indications for surgery were Graves’ disease (n=52; 49%), Multiple Endocrine Neoplasia type-2 (n=36; 34%), multinodular goiter (n=3; 3%) and follicular/papillary thyroid carcinoma (n=15; 14%). Neck dissection was performed in 23 children (19%) and autotransplantation in 14 children (13%). In 31 children (29%), ≥1 glands were found in the specimen.

Hypocalcaemia occurred within 24h of thyroidectomy in 63 children (59%) and 52 children (49.3%) were discharged on supplements. Hypoparathyroidism persisted at 6 months in 23 children (21.7%) and was more likely if < 4 parathyroid glands remained in situ.

Hypoparathyroidism is a very common complication after total thyroidectomy in adults and is at least as prevalent in children. This study highlights the need for expert, high—volume surgeons and improved imaging techniques that can visualize the often well-hidden parathyroid glands intraoperatively (1). In addition, adequate recognition and management is crucial to minimize the morbidity of post-thyroidectomy hypoparathyroidism.

Reference: 1. Benmiloud et al. Association of Autofluorescence-Based Detection of the Parathyroid Glands During Total Thyroidectomy With Postoperative Hypocalcemia Risk: Results of the PARAFLUO Multicenter Randomized Clinical Trial. JAMA Surg. 2020 Feb 1;155(2):106–112.