Choe Yunsoo, Lee Yun Jeong, Shin Choong Ho, Chung Eun-Jae, Lee Young Ah
Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of OtorhinolaryngologyHead and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea.
Ann Pediatr Endocrinol Metab. 2023 Mar;28(1):26-33. doi: 10.6065/apem.2244044.022. Epub 2022 Jun 28.
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.
This retrospective study included 98 patients younger than 20 years who were diagnosed with thyroid cancer after T T 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.
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.
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.
甲状旁腺功能减退症（甲旁减）是甲状腺切除术后最常见的并发症。我们调查了小儿甲状腺癌患者全甲状腺切除术后（TT）甲旁减的发生率及危险因素。
这项回顾性研究纳入了98例年龄小于20岁的患者，这些患者在1990年至2018年期间接受TT后被诊断为甲状腺癌，并在首尔国立大学医院随访超过2年。甲旁减定义为术后接受活性维生素D（1-羟胆钙化醇或1,25-二羟胆钙化醇）治疗。
该研究包括27例男孩（27.6%）和71例女孩（72.4%）。诊断时的平均年龄为14.9±3.7岁。43例患者（43.9%）发生了甲旁减。21例患者（21.4%）在术后不到6个月停用活性维生素D，而14例（14.3%）持续使用活性维生素D超过2年。肿瘤多灶性（比值比[OR]，3.7 vs单灶肿瘤；P=0.013）和术前血钙水平（OR，0.2；P=0.028）是TT术后立即发生甲旁减的独立预测因素。此外，年龄（OR，0.8；P=0.011）和术前血钙水平（OR，0.04；P=0.014）显著降低了需要活性维生素D治疗超过2年的持续性甲旁减的风险。
本研究中，小儿甲状腺癌患者TT术后43.9%发生甲旁减。其中，三分之一的患者持续使用活性维生素D药物超过2年，这可通过年轻和术前低血钙水平预测。
