Aweeda Marina, Fassler Carly, Habib Daniel R S, Miller Alexis B, Ortega Carlos, Prasad Kavita, Chen Chiu-Lan, Duffus Sara H, Belcher Ryan H
Department of Otolaryngology-Head and Neck Surgery Vanderbilt University Medical Center Nashville Tennessee USA.
Vanderbilt School of Medicine Nashville Tennessee USA.
OTO Open. 2025 May 23;9(2):e70130. doi: 10.1002/oto2.70130. eCollection 2025 Apr-Jun.
Postoperative hypocalcemia after total thyroidectomy (TT) affects pediatric patients at higher rates than adult patients, yet its rate remains poorly defined. This study aims to determine the rates of transient, permanent, and any hypocalcemia after TT in pediatric patients and analyze potential risk factors.
PubMed, EMBASE, Scopus, and Cochrane.
A database search was conducted through March 2024 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Data concerning postoperative hypocalcemia, risk factors, and clinical context were collected and analyzed. Transient hypocalcemia was defined as lasting less than 6 months and permanent as lasting greater than 6 months after surgery.
In total, 67 studies with 7331 pediatric patients met the inclusion criteria. Surgical indications for TT in this cohort included malignant conditions (54.75%), benign conditions (19.70%), Graves' disease (18.59%), genetic syndromes (MEN2A/2B, RET mutation) (6.04%), and Hashimoto's thyroiditis (0.92%). The pooled incidence rates were 25.2% (95% CI 0.20-0.31) for transient, 7.4% (95% CI 0.05-0.10) for permanent, and 32.1% (95% CI 0.26-0.39) for any hypocalcemia. Fifteen of the included studies also examined risk factors for postoperative hypocalcemia. Patients undergoing TT for malignancy (odds ratio [OR] 2.82, 95% CI [1.18-6.73]; = .02) or Graves' disease (OR 6.12, 95% CI [3.10-12.01]; < .0001), as well as those undergoing any lymph node dissection (OR 3.71, 95% CI [1.95-7.06]; < .0001) were at higher risk for postoperative hypocalcemia.
Hypocalcemia is a common postoperative complication of TT in pediatric patients. Risk factors include malignant surgical indication, Graves' disease, and any lymph node dissection.
全甲状腺切除术后（TT），小儿患者发生术后低钙血症的几率高于成人患者，但其发生率仍不明确。本研究旨在确定小儿患者TT术后短暂性、永久性及任何类型低钙血症的发生率，并分析潜在风险因素。
PubMed、EMBASE、Scopus和Cochrane。
根据系统评价和Meta分析的首选报告项目（PRISMA）指南，检索截至2024年3月的数据库。收集并分析有关术后低钙血症、风险因素及临床背景的数据。短暂性低钙血症定义为术后持续时间少于6个月，永久性低钙血症定义为术后持续时间大于6个月。
共有67项研究、7331例小儿患者符合纳入标准。该队列中TT的手术指征包括恶性疾病（54.75%）、良性疾病（19.70%）、Graves病（18.59%）、遗传综合征（MEN2A/2B、RET突变）（6.04%）和桥本甲状腺炎（0.92%）。短暂性低钙血症的合并发生率为25.2%（95%CI 0.20 - 0.31），永久性低钙血症为7.4%（95%CI 0.05 - 0.10），任何类型低钙血症为32.1%（95%CI 0.26 - 0.39）。纳入的15项研究还探讨了术后低钙血症的风险因素。因恶性疾病接受TT的患者（比值比[OR]2.82，95%CI[1.18 - 6.73]；P = 0.02）或Graves病患者（OR 6.12，95%CI[3.10 - 12.01]；P < 0.0001），以及接受任何淋巴结清扫的患者（OR 3.71，95%CI[1.95 - 7.06]；P < 0.0001）术后发生低钙血症的风险更高。
低钙血症是小儿患者TT术后常见的并发症。风险因素包括恶性手术指征、Graves病和任何淋巴结清扫。
