Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, Pisa, Italy.
Department of Surgical Pathology, Endocrine Surgery Division, University of Pisa, Pisa, Italy.
Pediatr Blood Cancer. 2022 Aug;69(8):e29576. doi: 10.1002/pbc.29576. Epub 2022 Feb 7.
Postoperative hypocalcemia is a frequent complication after thyroidectomy. Hypoparathyroidism may develop as transient (TtHP), with normalization within six months from surgery, or permanent (PtHP) if the patient requires replacement therapy. We analyzed factors associated with the development of postoperative hypoparathyroidism and in detail PtHP following thyroid surgery in a pediatric population.
A retrospective multicenter study analyzing 326 patients was carried out. We recorded gender, age, tumor size, thyroiditis, extrathyroidal extension, lymph node dissection (central/lateral compartment, unilateral/bilateral), parathyroid autotransplantation, and histology. Additionally, calcium levels were acquired postoperatively.
We analyzed pediatric patients ≤18 years who underwent thyroidectomy clustered into age groups (≤15 or > 15). Patients' mean follow-up was 5.8 years (1-11 years). Postoperative hypoparathyroidism occurred in 36 (11.0%): 20 cases (6.13%) developed PtHP. Postoperative hypoparathyroidism was more frequent in younger patients (P = 0.014), in larger tumors (P < 0.001), in case of extrathyroidal extension (P = 0.037), and in central compartment (P = 0.020) and bilateral lymph node dissection (P = 0.030). PtHP was more frequent in older patients (P = 0.014), in case of thyroiditis (P < 0.001), and extrathyroidal extension (P < 0.001). Concerning the first postoperative calcium level measurement, in the postoperative hypoparathyroidism group, we registered a 8.17 mg/dL value with 14% pre/postoperative decrease (Δ ), whereas in PtHP patient group calcium level was 7.91 mg/dL with 16.7% Δ .
The risk of postoperative hypoparathyroidism is related to younger age, tumor size, central compartment and bilateral lymph node dissection, extrathyroidal extension, and decrease in postoperative calcium levels. The risk of PtHP is related to older age, thyroiditis, extrathyroidal extension, and decrease in postoperative calcium levels.
甲状腺切除术后低钙血症是一种常见的并发症。甲状旁腺功能减退症可能表现为一过性（TtHP），即在手术后 6 个月内恢复正常，或者为永久性（PtHP），如果患者需要替代治疗。我们分析了与儿童甲状腺手术后甲状旁腺功能减退症发展及详细的 PtHP 相关的因素。
进行了一项回顾性多中心研究，分析了 326 例患者。我们记录了性别、年龄、肿瘤大小、甲状腺炎、甲状腺外延伸、淋巴结清扫（中央/侧方区，单侧/双侧）、甲状旁腺自体移植和组织学。此外，还获得了术后的血钙水平。
我们分析了≤18 岁的儿童患者，这些患者分为≤15 岁和>15 岁两个年龄组。患者的平均随访时间为 5.8 年（1-11 年）。术后甲状旁腺功能减退症发生 36 例（11.0%）：20 例（6.13%）发生 PtHP。年龄较小的患者（P=0.014）、肿瘤较大的患者（P<0.001）、有甲状腺外延伸的患者（P=0.037）、行中央区（P=0.020）和双侧淋巴结清扫的患者（P=0.030）术后甲状旁腺功能减退症更常见。年龄较大的患者（P=0.014）、有甲状腺炎的患者（P<0.001）和有甲状腺外延伸的患者（P<0.001）更易发生 PtHP。关于术后第一次血钙测量值，在甲状旁腺功能减退症组中，我们记录的血钙值为 8.17mg/dL，术后下降 14%（Δ），而在 PtHP 患者组中，血钙值为 7.91mg/dL，术后下降 16.7%（Δ）。
术后甲状旁腺功能减退症的风险与年龄较小、肿瘤较大、中央区和双侧淋巴结清扫、甲状腺外延伸以及术后血钙水平下降有关。PtHP 的风险与年龄较大、甲状腺炎、甲状腺外延伸以及术后血钙水平下降有关。
