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Factors associated with postoperative hypocalcemia following surgery for thyroid cancer in childhood
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  • Claudio Spinelli,
  • Marco Ghionzoli,
  • Alessia Bertocchini,
  • Beatrice Sanna,
  • Carlotta Plessi,
  • Luigi De Napoli,
  • Gianluca Frustaci,
  • Gabriele Materazzi,
  • Alessandro Antonelli,
  • Fabrizio Gennari,
  • Alessandro Inserra,
  • Gianni Bisogno,
  • Piergiorgio Gamba,
  • Andrea Ferrari,
  • Maura Massimino
Claudio Spinelli
University of Pisa
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Marco Ghionzoli
University of Pisa
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Alessia Bertocchini
University of Pisa
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Beatrice Sanna
University of Pisa
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Carlotta Plessi
University of Siena
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Luigi De Napoli
University of Pisa
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Gianluca Frustaci
University of Pisa
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Gabriele Materazzi
University of Pisa
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Alessandro Antonelli
University of Pisa
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Fabrizio Gennari
Regina Margherita Children's Hospital
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Alessandro Inserra
Ospedale Pediatrico Bambino Gesù
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Gianni Bisogno
University of Padua
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Piergiorgio Gamba
University of Padua
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Andrea Ferrari
Fondazione IRCCS Istituto Nazionale dei Tumori
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Maura Massimino
Fondazione IRCCS Istituto Nazionale dei Tumori
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Abstract

Background: Postoperative hypocalcemia is a frequent complication after thyroid surgery. Hypoparathyroidism may develop as transient (TtHP), with normalization within six months from surgery, or permanent (PtHP) if the patient requires replacement therapy. The present study analyzes rates and factors associated with the development of TtHP or PtHP following thyroid surgery in a pediatric population. Procedure: A retrospective multicenter study analyzing 363 patients was carried out. We recorded gender, age, tumor size, type of surgery, lymph node dissection, histology. Calcium levels were acquired daily for 72 hours after discharge. Subsequent sample collection was customized on the patient’s hypocalcemia severity. Results: We analyzed 363 patients aged ≤18 years (mean age 14.2 years) who underwent thyroid surgery clustered into age groups (≤15 or >15). Patients mean follow-up was 5.8 years (1-11yrs). At histology 310 (85%) were papillary carcinoma, 32 (9%) were follicular carcinoma, 6 (2%) presented diffuse sclerosing variant of papillary thyroid carcinoma whilst 15 (4%) had familial medullary carcinoma. TtHP developed in 36 (9,9%), PtHP in 20 (5.5%) cases. TtHP was more frequent in younger patients (p=0,009). Both PtHP and TtHP were increased in case of larger tumors (≥2 cm) (p=0,001). All TtHP and PtHP were in TT group. PtHP rate was increased if lymph node dissection was carried out (p<0.001). Conclusions: The risk of hypoparathyroidism is related to younger age, tumor size, TT and lymph node dissection therefore surgeons should tailor surgery as much as possible to avert such complication.

Peer review status:UNDER REVIEW

28 May 2021Submitted to Pediatric Blood & Cancer
28 May 2021Submission Checks Completed
28 May 2021Assigned to Editor
01 Jun 2021Reviewer(s) Assigned
15 Jun 2021Review(s) Completed, Editorial Evaluation Pending
16 Jun 2021Editorial Decision: Revise Major
03 Sep 20211st Revision Received
03 Sep 2021Submission Checks Completed
03 Sep 2021Assigned to Editor
11 Sep 2021Reviewer(s) Assigned