Improving Safety in Pediatric Thyroidectomy by PTH Measurements

Study Overview
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Brief Summary
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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
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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.

Official Title
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Implementation of PTH Measurement Intra / Post Thyroidectomy to Improve Post Surgical Safety in Pediatric Patients

Conditions
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Hypoparathyroidism Postprocedural

Intervention / Treatment
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* Diagnostic Test: PTH measurements post-thyroidectomy (at 5 and 60 min post thyroid removal)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients who underwent total thyroidectomy between January 2014 and April 2020 Exclusion Criteria: 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

Ages Eligible for Study
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Minimum Age: 2 Years
Maximum Age: 19 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Diagnostic Test: PTH measurements post-thyroidectomy (at 5 and 60 min post thyroid removal)|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.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Biochemical hypocalcemia post thyroidectomy occurrence | total Calcium level < 8 mg/dl | 48 hours postthyroidectomy | 
| Symptomatic hypocalcemia post thyroidectomy ocurrence | Signs o symptoms of hypocalcemia (Chvostek or Trousseau signs, tingling, numbness, muscle cramps, spasms, tetany or seizures | 48 hours posthyroidectomy | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| days of hospitalization after thyroidectomy | number of days that patient need hospitalization (high risk group) | up to 15 days after thyroidectomy | 
| number of Calcium sampling | number of venipuncture performed to control serum calcium level (low risk group) | 48 hours postthyroidectomy | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Thyroidectomy, PTH, Pediatric surgery, hypocalcemia