Potential determinants and predictors of hypoparathyroidism after total thyroidectomy in pediatric patients

Objective: Few studies have reported risk factors for post-thyroidectomy hypoparathyroidism (HPT) in children. We aimed to identify predicting factors for transient and permanent HPT after total thyroidectomy in pediatric patients. Study design: Retrospective review of medical charts. Setting: A tertiary university-affiliated medical center. Methods: A retrospective study of all children who underwent thyroid surgery between 2001 and 2019. Results: The study included 70 patients. Sixteen patients (23%) had postoperative HPT: 10 transient (14%) and 6 permanent (9%). Central compartment neck dissection, larger nodular size, malignant disease, and extrathyroidal extension (ETE) were associated with overall HPT. ETE (p = 0.034) and younger age at diagnosis (median 10.5 vs. 14.5 years, p = 0.035) were associated with permanent HPT. Several calcium indices were associated with permanent HPT, including first calcium level, minimal calcium level, and the decrease in calcium level after surgery. Conclusions: Patients under 10.5 years of age and those presenting with ETE are at potential risk of developing permanent HPT after total thyroidectomy. Postoperative calcium levels may have a role as a predictor of permanent HPT and should be considered in the decision on calcium monitoring and supplementation.