Annabel S Zaat1, Joep P M Derikx2, Nitash Zwaveling-Soonawala1, A S Paul van Trotsenburg1, Christiaan F Mooij1. 1. Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. 2. Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands.
Abstract
BACKGROUND: Graves' disease (GD) is the most common cause of hyperthyroidism. In children, the overall relapse frequency after treatment with antithyroid drugs is high. Therefore, many pediatric GD patients eventually require thyroidectomy as definitive treatment. However, the postoperative complications of thyroidectomy in pediatric GD patients are poorly reported. OBJECTIVE: To identify the frequency of short- and long-term postoperative morbidities after thyroidectomy in pediatric GD patients. METHODS: A systematic review of the literature (PubMed and Embase) was performed to identify studies reporting short- and long-term postoperative morbidities after thyroidectomy in pediatric GD patients according to the PRISMA guidelines. RESULTS: Twenty-two mainly retrospective cohort studies were included in this review evaluating short- and long-term morbidities in 1,424 children and adolescents. The frequency of transient hypocalcemia was 22.2% (269/1,210), with a range of 5.0-50.0%. The frequency of permanent hypocalcemia was 2.5% (36/1,424), with a range of 0-20.0%. Two studies reported high frequencies of permanent hypocalcemia, 20.0 (6/30) and 17.4% (9/52), respectively. The 20% frequency could be explained by low-volume surgeons in poorly controlled GD patients. Only 21 cases of permanent hypocalcemia were reported in the 1,342 patients included in the other 20 studies (1.6%). Transient and permanent recurrent laryngeal nerve injury were reported less frequently, with frequencies between 0-20.0 and 0-7.1%, respectively. Infection, hemorrhage/hematoma, and keloid development were only rarely reported as postoperative complications. CONCLUSION: The results of this systematic review suggest that thyroidectomy is a safe treatment option for pediatric GD patients. The minority of patients will experience transient and benign morbidities, with hypocalcemia being the most common transient postoperative morbidity. Permanent postoperative morbidities are relatively rare.
BACKGROUND: Graves' disease (GD) is the most common cause of hyperthyroidism. In children, the overall relapse frequency after treatment with antithyroid drugs is high. Therefore, many pediatric GD patients eventually require thyroidectomy as definitive treatment. However, the postoperative complications of thyroidectomy in pediatric GD patients are poorly reported. OBJECTIVE: To identify the frequency of short- and long-term postoperative morbidities after thyroidectomy in pediatric GD patients. METHODS: A systematic review of the literature (PubMed and Embase) was performed to identify studies reporting short- and long-term postoperative morbidities after thyroidectomy in pediatric GD patients according to the PRISMA guidelines. RESULTS: Twenty-two mainly retrospective cohort studies were included in this review evaluating short- and long-term morbidities in 1,424 children and adolescents. The frequency of transient hypocalcemia was 22.2% (269/1,210), with a range of 5.0-50.0%. The frequency of permanent hypocalcemia was 2.5% (36/1,424), with a range of 0-20.0%. Two studies reported high frequencies of permanent hypocalcemia, 20.0 (6/30) and 17.4% (9/52), respectively. The 20% frequency could be explained by low-volume surgeons in poorly controlled GD patients. Only 21 cases of permanent hypocalcemia were reported in the 1,342 patients included in the other 20 studies (1.6%). Transient and permanent recurrent laryngeal nerve injury were reported less frequently, with frequencies between 0-20.0 and 0-7.1%, respectively. Infection, hemorrhage/hematoma, and keloid development were only rarely reported as postoperative complications. CONCLUSION: The results of this systematic review suggest that thyroidectomy is a safe treatment option for pediatric GD patients. The minority of patients will experience transient and benign morbidities, with hypocalcemia being the most common transient postoperative morbidity. Permanent postoperative morbidities are relatively rare.
Authors: Mehul V Raval; Marybeth Browne; Anthony C Chin; Donald Zimmerman; Peter Angelos; Marleta Reynolds Journal: J Pediatr Surg Date: 2009-08 Impact factor: 2.545
Authors: C K Sinha; Paolo Decoppi; Agostino Pierro; Caroline Brain; Peter Hindmarsh; Gary Butler; Mehul Dattani; Helen Spoudeas; Tom R Kurzawinski Journal: Eur J Pediatr Surg Date: 2014-08-21 Impact factor: 2.191
Authors: Heron D Baumgarten; Andrew J Bauer; Amber Isaza; Sogol Mostoufi-Moab; Ken Kazahaya; N Scott Adzick Journal: J Pediatr Surg Date: 2019-02-28 Impact factor: 2.545
Authors: Charles T Tuggle; Sanziana A Roman; Tracy S Wang; Leon Boudourakis; Daniel C Thomas; Robert Udelsman; Julie Ann Sosa Journal: Surgery Date: 2008-12 Impact factor: 3.982
Authors: Mechteld de Jong; Hassan Nounou; Virginia Rozalén García; Ioannis Christakis; Caroline Brain; Tarek E Abdel-Aziz; Richard J Hewitt; Tom R Kurzawinski Journal: J Pediatr Surg Date: 2019-07-19 Impact factor: 2.545
Authors: Sarah L Lutterman; Nitash Zwaveling-Soonawala; Hein J Verberne; Frederik A Verburg; A S Paul van Trotsenburg; Christiaan F Mooij Journal: Eur Thyroid J Date: 2021-07-12
Authors: Jesse J van Rooijen; A S Paul van Trotsenburg; Daniël J van de Berg; Nitash Zwaveling-Soonawala; Els J M Nieveen van Dijkum; Anton F Engelsman; Joep P M Derikx; Christiaan F Mooij Journal: Front Endocrinol (Lausanne) Date: 2021-09-29 Impact factor: 5.555
Authors: Christiaan F Mooij; Timothy D Cheetham; Frederik A Verburg; Anja Eckstein; Simon H Pearce; Juliane Léger; A S Paul van Trotsenburg Journal: Eur Thyroid J Date: 2022-01-01