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KMID : 1036920230280010026
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Annals of Pediatric Endocrinology & Metabolism
2023 Volume.28 No. 1 p.26 ~ p.33
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Risk factors of postoperative hypoparathyroidism after total thyroidectomy in pediatric patients with thyroid cancer
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Choe Yun-Soo
Lee Yun-Jeong
Shin Choong-Ho
Chung Eun-Jae
Lee Young-Ah
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Abstract
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Purpose: Hypoparathyroidism (hypoPTH) is the most common complication following thyroidectomy. We investigated the frequency and risk factors of hypoPTH after total thyroidectomy (TT) in pediatric patients with thyroid cancer.
Methods: This retrospective study included 98 patients younger than 20 years who were diagnosed with thyroid cancer after TT during 1990?2018 and followed for more than 2 years at Seoul National University Hospital. HypoPTH was defined as receiving active vitamin D (1-hydroxycholecalciferol or 1,25-dihydroxycholecalciferol) after surgery.
Results: The study included 27 boys (27.6%) and 71 girls (72.4%). The mean age at diagnosis was 14.9±3.7 years. HypoPTH occurred in 43 patients (43.9%). Twenty-one patients (21.4%) discontinued active vitamin D less than 6 months after surgery, while 14 (14.3%) continued active vitamin D for more than 2 years. Tumor multifocality (odds ratio [OR], 3.7 vs. single tumor; P=0.013) and preoperative calcium level (OR, 0.2; P=0.028) were independent predictors of hypoPTH immediately after TT. In addition, age (OR, 0.8; P=0.011) and preoperative calcium level (OR, 0.04; P=0.014) significantly decreased the risk for persistent hypoPTH requiring active vitamin D for more than 2 years.
Conclusion: HypoPTH occurred in 43.9% of pediatric thyroid cancer patients after TT in this study. Among them, one-third of patients continued active vitamin D medication for more than 2 years, which was predicted by young age and low preoperative calcium level.
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KEYWORD
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Thyroid neoplasm, Thyroidectomy, Hypoparathyroidism, Hypocalcemia, Parathyroid hormone
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