Improving Safety in Pediatric Thyroidectomy by PTH Measurements
Condition: Hypoparathyroidism Postprocedural
MeSH terms: Hypoparathyroidism
Study type: Observational

Summary: 
      We implemented a previously reported algorithm based on intra-postoperative PTH measurements
      with selected cut-off values, both to predict post-thyroidectomy hypoparathyroid
      hypocalcemia, and to guide postsurgical management. The objective of the study was to assess
      if this strategy was useful to reduce hypocalcemia, post-surgery calcium sampling and
      hospitalization length.
    

Detailed description: 
      Sixty-six patients were included in the analysis. Based on their intra-operatory PTH
      determinations, patients were classified according to their post-surgical hypoparathyroidism
      risk and were either immediately treated with calcium and vitamin D1-25 supplementation
      (high-risk) or assigned to clinical control and routine calcium sampling (low-risk). The
      outcomes and overall results of these therapeutical approaches were compared with those of a
      control group, started on treatment when TCa levels dropped below normal.

      In the high-risk subgroup (n=30) five patients showed hypocalcemia within the first 24 hours.
      Compared with the high-risk control subgroup, the incidence of hypocalcemia fell from 100% to
      17% (p<0.001), and the median hospitalization length from 6 to 3 days (p<0.001).

      In the low-risk subgroup (n=36) 28 patients remained normocalcemic with significantly less
      calcium sampling (p<0.001). Eight patients had hypocalcemia; 7 of them required neck
      dissection, which was the only risk factor related to post-surgical hypoparathyroidism (RR:
      2.1 [CI 95% 1.4-3.1], P<0.001).

      Compared to the control group, overall incidence of hypocalcemia was reduced by 58 %.

      This approach improved patient's safety by reducing the occurrence of hypocalcemia and the
      length of hospitalization after thyroidectomy in pediatric patients. Preventive calcium
      supplementation seems to be more beneficial in patients undergoing neck dissection.
    

Intervention name(s): PTH measurements post-thyroidectomy (at 5 and 60 min post thyroid removal)
Intervention type(s): Diagnostic Test
Intervention description(s): We implement an algorithm employing PTH levels post-thyroidectomy to stratify patients according to their postsurgical risk for hypoparathyroidism, and to distinctively manage them in the immediate postsurgical period. High risk patients are quickly supplemented with Calcium iv and activated 25OH vitamin D. Low risk patients are clinically controlled and calcium level were checked at 24 and 48 hs post thyroidectomy.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        All patients between 2 and 19 years of age who underwent total thyroidectomy at Hospital de
        Niños Ricardo Gutiérrez in Buenos Aires, Argentina between January 2014 and April 2020 were
        included. Exclusion criteria were patients with known hyper or hypoparathyroidism, kidney
        failure, and those taking medications known to affect TCa, PTH, or vitamin D levels
        (octreotide, oral glucocorticoids, diuretics and antiepileptics), or any other condition
        that could interfere with calcium metabolism.
      
Keywords: Thyroidectomy; PTH; Pediatric surgery; hypocalcemia