Thyroidectomy in Pediatric Patients with Graves’ Disease: A Systematic Review of Postoperative Morbidity

Zaat, Annabel S; Derikx, Joep P. M.; Zwaveling-Soonawala, Nitash; Trotsenburg, A S Paul van; Mooij, Christiaan F.

doi:10.1159/000511345

Cited by 15 publications

(24 citation statements)

References 39 publications

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“…Due to the invasive character of laryngoscopy, it is not routinely used in pediatric patient care after thyroidectomy ( 1 , 10 , 23 , 24 ). As we believe transient (and permanent) RLN injury is only clinically relevant if symptoms like hoarseness persist after the direct postoperative period, we only classified patients with RLN injury when they were referred to a speech therapist ( 34 ). A key aspect in avoiding RLN injury during the operation is identification of the RLN ( 35 ).…”

Section: Discussionmentioning

confidence: 99%

Complications After Thyroidectomy in Children: Lymph Node Dissection Is a Risk Factor for Permanent Hypocalcemia

et al. 2021

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BackgroundThyroidectomy is a treatment option in some benign thyroid disorders and the definitive treatment option for thyroid cancer. As postoperative mortality is extremely rare data on postoperative complications and long-term health consequences are important.ObjectiveTo evaluate the frequencies of short- and long-term complications, and their risk factors in pediatric patients (0-18 years) who underwent a thyroidectomy in a tertiary children’s hospital.MethodsA retrospective single center study was performed including all pediatric patients who underwent a thyroidectomy between January 2013 and February 2020.ResultsForty-eight patients were included in this study (mean age 14.6 years). Twenty-nine total thyroidectomies and 19 hemithyroidectomies were conducted. Thyroid carcinoma was the indication to perform a thyroidectomy in 12 patients, 36 patients underwent a thyroidectomy because of a benign thyroid disorder. Postoperative hypocalcemia was evaluated in patients who underwent a total thyroidectomy. Rapidly resolved hypocalcemia was observed in three patients (10.3%), transient hypocalcemia in 10 patients (34.5%) and permanent hypocalcemia in six patients (20.7%). Permanent hypocalcemia was only seen in patients who underwent a thyroidectomy combined with additional lymph node dissection because of thyroid carcinoma [thyroid carcinoma: OR 43.73, 95% CI (2.11-904.95); lymph node dissection: OR 76.14, 95% CI (3.49-458.98)]. Transient and permanent recurrent laryngeal nerve injury was reported in four (8.3%) and one (2.1%) of all patients, respectively.ConclusionPermanent postoperative complications after thyroidectomy are rare in pediatric patients undergoing a thyroidectomy without lymph node dissection. However, in this age group permanent hypocalcemia occurs more frequently after thyroidectomy with additional lymph node dissection because of thyroid cancer. With respect to quality of life, especially of pediatric thyroid cancer patients, reducing this complication is an important goal.

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Section: Discussionmentioning

confidence: 99%

Complications After Thyroidectomy in Children: Lymph Node Dissection Is a Risk Factor for Permanent Hypocalcemia

et al. 2021

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“…The final decision on what option to follow will involve shared decision-making including the patient and parents, focusing on the (dis)advantages of each option and local expertise. Total thyroidectomy is a safe treatment option in pediatric GD patients, especially if performed by high-volume surgeons [6]. Only in a minority of pediatric patients, irreversible complications of surgery like permanent hypocalcemia (2.5%) or recurrent laryngeal nerve injury (0.4%) have been reported [6].…”

Section: Introductionmentioning

confidence: 99%

“…Total thyroidectomy is a safe treatment option in pediatric GD patients, especially if performed by high-volume surgeons [6]. Only in a minority of pediatric patients, irreversible complications of surgery like permanent hypocalcemia (2.5%) or recurrent laryngeal nerve injury (0.4%) have been reported [6]. Furthermore, thyroidectomy is potentially associated with general surgical risks and consequences, like postoperative bleeding, infections, and a permanent scar.…”

Section: Introductionmentioning

confidence: 99%

The Efficacy and Short- and Long-Term Side Effects of Radioactive Iodine Treatment in Pediatric Graves’ Disease: A Systematic Review

Lutterman¹,

Zwaveling-Soonawala²,

Verberne³

et al. 2021

Eur Thyroid J

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Background: Graves’s disease (GD) is the most common cause of hyperthyroidism. Maximal 30% of pediatric GD patients achieve remission with antithyroid drugs. The majority of patients therefore require definitive treatment. Both thyroidectomy and radioactive iodine (RAI) are often used as definitive treatment for GD. However, data on efficacy and short- and long-term side effects of RAI treatment for pediatric GD are relatively scarce. Methods: A systematic review of the literature (PubMed and Embase) was performed to identify studies reporting the efficacy or short- and long-term side effects of RAI treatment in pediatric GD. Results: Twenty-three studies evaluating 1,283 children and adolescents treated with RAI for GD were included. The treatment goal of RAI treatment changed over time, from trying to achieve euthyroidism in the past to aiming at complete thyroid destruction and subsequent hypothyroidism in the last 3 decades. The reported efficacy of a first RAI treatment when aiming at hypothyroidism ranged from 42.8 to 97.5%, depending on the activity administered. The efficacy seems to increase with higher RAI activities. When aiming at hypothyroidism, both short- and long-term side effects of treatment are very rare. Long-term side effects were mainly seen in patients in whom treatment aimed at achieving euthyroidism. Conclusion: RAI is a safe definitive treatment option for pediatric GD when aiming at complete thyroid destruction. When aiming at hypothyroidism, the efficacy of treatment seems to increase with a higher RAI activity. Prospective studies are needed to determine the optimal RAI dosing regimen in pediatric GD.

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“…Thyroidectomy is one of the most common surgeries with low morbidities [ 1 ], which is related to the skill and experience of the surgeon [ 2 ]. Because thyroid surgery is performed in an area with a complex anatomy, nerves, glands and surrounding vessels are at risk of damage [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Hypocalcemia following total and subtotal thyroidectomy and associated factors

Azadbakht

Emadi-jamali

Azadbakht

2021

Annals of Medicine &Amp; Surgery

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Background Thyroidectomy is one of the common endocrinological surgeries for the treatment of thyroid disorders. Hypocalcemia is the potential complication after thyroidectomy, where is persistency can lead to serious systemic effects. The aim of this study is to evaluate the incidence of hypocalcemia in thyroidectomy patients. Methods In this cross-sectional study, patients referred to (XXX) for thyroidectomy from 2019 to 2020 were enrolled. Preoperative serum calcium and postoperative 24- and 48-h calcium levels were evaluated in these patients. Demographic data (sex and gender), calcium levels, type of thyroidectomy and duration of surgery was recorded for all the patients. SPSS v22 was used for statistical analysis. P < 0.05 was considered as statistically significant. Results Of 143 patients included in the study, the mean age was 49.7 ± 10.9 years and 61.5% were females and 38.5% were males. 49% patients had hypocalcemia in the first 24 hours after surgery and 63.6% following 48 hours of the surgery. The difference in calcium levels at three intervals were statistically significant, p = 0.001. The incidence of hypocalcemia was significantly more in women at 48 postoperative hours, p = 0.025. The age and duration of surgery was not significantly correlated with hypocalcemia, p > 0.05, whereas, patients who underwent total thyroidectomy had greater incidence of hypocalcemia 24 hours after the surgery, p = 0.021. Conclusions The incidence of hypocalcemia is greater in total thyroidectomy and female patients. Our study did not report significant correlation between duration of the surgery and age of the patients.

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Thyroidectomy in Pediatric Patients with Graves’ Disease: A Systematic Review of Postoperative Morbidity

Cited by 15 publications

References 39 publications

Complications After Thyroidectomy in Children: Lymph Node Dissection Is a Risk Factor for Permanent Hypocalcemia

Complications After Thyroidectomy in Children: Lymph Node Dissection Is a Risk Factor for Permanent Hypocalcemia

The Efficacy and Short- and Long-Term Side Effects of Radioactive Iodine Treatment in Pediatric Graves’ Disease: A Systematic Review

Hypocalcemia following total and subtotal thyroidectomy and associated factors

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