title: Pediatric thyroidectomy in a high volume thyroid surgery center: Risk factors for postoperative hypocalcemia.
abstract: BACKGROUND
  Hypocalcemia is a common complication following thyroid surgery. We seek to report on our experience in pediatric thyroidectomy in a high volume thyroid surgery center and accurately assess the incidence of postoperative hypocalcemia.
  
  
  METHODS
  A retrospective review of patients aged 18 and younger who underwent thyroid surgery between 1992 and 2013. The primary endpoints were the occurrence of postoperative hypocalcemia as by defined as a nadir calcium <8.0mg/dL and being discharged on oral calcium supplementation, need for intravenous calcium and the occurrence of permanent hypoparathyroidism.
  
  
  RESULTS
  171 patients who underwent 186 thyroid operations were analyzed. The average age was 15.4years with 82.3% female. The most common indications for surgery were nodular disease (74.7%) and hyperthyroidism (12.4%). 24 patients (12.9%) experienced postoperative hypocalcemia with 13 (7.0%) requiring intravenous calcium infusion. One patient (0.9%) experienced permanent hypoparathyroidism. Risk factors for postoperative hypocalcemia included total thyroidectomy (OR 7.39, p<0.01), central and bilateral lateral neck dissection (OR 22.26, p=0.01), Graves' disease (OR 3.99, p=0.02), and malignancy (OR 2.96, p=0.03).
  
  
  CONCLUSIONS
  Pediatric patients who undergo total thyroidectomy for underlying malignancy or Graves' disease and those who have more extensive nodal dissections are at increased risk of developing this postoperative hypocalcemia. These patients may benefit from more vigilant preoperative preparation and postoperative calcium and vitamin D supplementation.
authors.affiliation: Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: ychen49@partners.org.
authors.forename: Yufei
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: pmasiakos@partners.org.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Masiakos
authors.affiliation: Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: gaz.randall@mgh.harvard.edu.
authors.forename: Randall D
authors.initials: RD
authors.lastname: Gaz
authors.affiliation: Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: rhodin@mgh.harvard.edu.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hodin
authors.affiliation: Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: sparangi@mgh.harvard.edu.
authors.forename: Sareh
authors.initials: S
authors.lastname: Parangi
authors.affiliation: Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA. Electronic address: gwrandolph@mgh.harvard.edu.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Randolph
authors.affiliation: Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: psadow@partners.org.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Sadow
authors.affiliation: Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: astephen@partners.org.
authors.forename: Antonia E
authors.initials: AE
authors.lastname: Stephen
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D006996:Hypocalcemia / Q000453:epidemiology / Q000209:etiology*; D007011:Hypoparathyroidism / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013531:Surgicenters; D013959:Thyroid Diseases / Q000601:surgery*; D013965:Thyroidectomy; D016896:Treatment Outcome
keywords: Endocrine; Hypocalcemia; Pediatric; Thyroidectomy