Long-term follow-up data may help manage patient and parent expectations for pediatric patients undergoing thyroidectomy

• Published in: Surgery 2012-12, Vol.152 (6), p.1165-1171
• Main Authors: Morris, Lilah F., MD, Waguespack, Steven G., MD, Warneke, Carla L., MS, Ryu, Haengrang, MD, Ying, Anita K., MD, Anderson, Barbara J., PhD, Sturgis, Erich M., MD, MPH, Clayman, Gary L., MD, Lee, Jeffrey E., MD, Evans, Douglas B., MD, Grubbs, Elizabeth G., MD, Perrier, Nancy D., MD, FACS
• Format: Article
• Language: English
• Subjects: Adolescent; Biological and medical sciences; Child; Child, Preschool; Female; General aspects; Humans; Hypoparathyroidism - diagnosis; Hypoparathyroidism - drug therapy; Hypoparathyroidism - etiology; Hypothyroidism - blood; Hypothyroidism - drug therapy; Hypothyroidism - etiology; Male; Medical sciences; Medication Adherence; Parents - psychology; Postoperative Care; Postoperative Complications; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of endocrine glands; Thyroid Neoplasms - psychology; Thyroid Neoplasms - surgery; Thyroidectomy - adverse effects; Thyrotropin - blood; Thyroxine - therapeutic use
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2012.08.056

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. Conclusion 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.