Children face higher hormone risk in thyroid removal surgery
Researchers say reduced blood supply is likely reason
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Children are more likely than adults to develop hypoparathyroidism after total thyroidectomy, probably because this surgery to remove the thyroid glands can disrupt their blood supply even when the nearby parathyroid glands are not accidentally removed, a study suggested.
However, “permanent hypoparathyroidism was uncommon,” researchers wrote in the study, “Pediatric Increased Risk and Nonlinear Age-Dependent Risk of Hypoparathyroidism After Total Thyroidectomy: A 1914-Patient Cohort Study,” published in the World Journal of Surgery.
Thyroid surgery can cause hypoparathyroidism — either temporarily or permanently — if the nearby parathyroid glands are damaged or accidentally removed. Hypoparathyroidism symptoms result from low levels of the parathyroid hormone (PTH), which controls the amount of calcium and phosphorus in circulation. PTH is produced in the parathyroid glands.
Scientists don’t fully understand how a patient’s age affects the risk of developing hypoparathyroidism. Researchers in Italy looked at 1,914 patients who had their first total thyroidectomy at a medical center where this type of surgery is frequently performed. Of the 1,914 patients, 1,827 were adults and 87 were children or adolescents.
The patients had either Graves’ disease, an autoimmune disease that causes an overactive thyroid, or differentiated thyroid cancer, the most common type of thyroid cancer. Transient hypoparathyroidism occurred in 314 (17.2%) adults and 26 (29.9%) pediatric patients, and permanent hypoparathyroidism, continuing for more than one year after surgery, occurred in eight (0.4%) adults and three (3.4%) pediatric patients.
Increased risk
After accounting for factors such as the reason for surgery, children and adolescents were still more likely to develop hypoparathyroidism. The odds of temporary hypoparathyroidism were 1.86 times higher in children and adolescents than in adults, while the odds of permanent hypoparathyroidism were 5.74 times higher. Other complications did not differ significantly between pediatric patients and adults.
Accidental removal of the parathyroid glands explained only one case of hypoparathyroidism in a child. The researchers said the findings suggest that devascularization — when the blood supply is damaged or interrupted during surgery — may be the main reason for the higher odds in children. Even when the parathyroid glands are left in place, reduced blood flow can prevent them from working normally.
“Pediatric patients undergoing primary total thyroidectomy are at increased risk of postoperative hypoparathyroidism independent of surgical indication and extent, even under uniform high‐volume surgical conditions, with devascularization the likely mechanism,” they wrote.
Among adults, the researchers found a non-linear relationship between age and postoperative hypoparathyroidism, meaning the odds did not increase or decrease steadily with age. Patients aged 40-50 were more likely to develop temporary hypoparathyroidism, with 1.5 times the odds compared with other adult age groups.
“Within adults, the risk of transient hypoparathyroidism varied non‐linearly with age, peaking at 40–50 years,” the researchers wrote. They said this “likely reflects disease presentation and operative complexity rather than chronological age alone.”
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