title: Long-term follow-up data may help manage patient and parent expectations for pediatric patients undergoing thyroidectomy.
abstract: BACKGROUND
  We investigated the incidence and impact of postoperative complications in children who underwent total thyroidectomy (TTx).
  
  
  METHODS
  The records of all pediatric patients undergoing TTx (2001-2011) at our institution were retrospectively reviewed for the occurrence of biochemical hypothyroidism (thyroid-stimulating hormone >10 mIU/mL), laboratory assessments, and medication nonadherence.
  
  
  RESULTS
  The 74 patients (median age, 12.5 years) had thyroid cancer (differentiated, n = 39; medullary, n = 16) or benign pathology (n = 19; 16 with multiple endocrine neoplasia type 2A). The median postoperative follow-up was 3.2 years; 46 patients (62%) had ≥ 1 year follow-up. Forty-one percent had ≥ 1 period of medication nonadherence; this was not associated with age at TTx (P = .30). Non-treatment-related hypothyroidism occurred in 33% of patients during postoperative year (POY) 1. The number of POY1 laboratory assessments among the 30% of patients with parathyroid dysfunction was more than twice that among patients with normal parathyroid function (median assessments per year 8 vs 3; P < .0001). Forty-four percent of patients/families reported behavioral or physiologic changes; 40% were concomitant with abnormal thyroid function.
  
  
  CONCLUSIONS
  More than 40% of pediatric patients were unable to fully adhere to postoperative medication regimens, and non-treatment-related hypothyroidism was common. Postoperative hypoparathyroidism doubled the number of laboratory assessments obtained. These data may help families better prepare for TTx sequelae.
authors.affiliation: Section of Surgical Endocrinology, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77230-1402, USA.
authors.forename: Lilah F
authors.initials: LF
authors.lastname: Morris
authors.forename: Steven G
authors.initials: SG
authors.lastname: Waguespack
authors.forename: Carla L
authors.initials: CL
authors.lastname: Warneke
authors.forename: Haengrang
authors.initials: H
authors.lastname: Ryu
authors.forename: Anita K
authors.initials: AK
authors.lastname: Ying
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Anderson
authors.forename: Erich M
authors.initials: EM
authors.lastname: Sturgis
authors.forename: Gary L
authors.initials: GL
authors.lastname: Clayman
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Lee
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Evans
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Grubbs
authors.forename: Nancy D
authors.initials: ND
authors.lastname: Perrier
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007011:Hypoparathyroidism / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D007037:Hypothyroidism / Q000097:blood / Q000188:drug therapy / Q000209:etiology; D008297:Male; D055118:Medication Adherence; D010290:Parents / Q000523:psychology*; D011182:Postoperative Care; D011183:Postoperative Complications; D013964:Thyroid Neoplasms / Q000523:psychology / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000627:therapeutic use
chemical_list: D013972:Thyrotropin; D013974:Thyroxine