دورية أكاديمية
Improving safety in paediatric thyroidectomy by PTH measurements.
| العنوان: | Improving safety in paediatric thyroidectomy by PTH measurements. |
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| المؤلفون: | Freire AV; Centro de Investigaciones Endocrinológicas 'Dr. César Bergadá' (CEDIE) -CONICET - FEI - División de Endocrinología, Hospital de Niños 'Ricardo Gutiérrez', Buenos Aires, Argentina., Ropelato MG; Centro de Investigaciones Endocrinológicas 'Dr. César Bergadá' (CEDIE) -CONICET - FEI - División de Endocrinología, Hospital de Niños 'Ricardo Gutiérrez', Buenos Aires, Argentina., Papendieck P; Centro de Investigaciones Endocrinológicas 'Dr. César Bergadá' (CEDIE) -CONICET - FEI - División de Endocrinología, Hospital de Niños 'Ricardo Gutiérrez', Buenos Aires, Argentina., Vieites A; Centro de Investigaciones Endocrinológicas 'Dr. César Bergadá' (CEDIE) -CONICET - FEI - División de Endocrinología, Hospital de Niños 'Ricardo Gutiérrez', Buenos Aires, Argentina., Elías E; Cirugía, Hospital de Niños 'Ricardo Gutiérrez', Buenos Aires, Argentina., Ballerini MG; Centro de Investigaciones Endocrinológicas 'Dr. César Bergadá' (CEDIE) -CONICET - FEI - División de Endocrinología, Hospital de Niños 'Ricardo Gutiérrez', Buenos Aires, Argentina., Rodriguez ME; Centro de Investigaciones Endocrinológicas 'Dr. César Bergadá' (CEDIE) -CONICET - FEI - División de Endocrinología, Hospital de Niños 'Ricardo Gutiérrez', Buenos Aires, Argentina., Bergadá I; Centro de Investigaciones Endocrinológicas 'Dr. César Bergadá' (CEDIE) -CONICET - FEI - División de Endocrinología, Hospital de Niños 'Ricardo Gutiérrez', Buenos Aires, Argentina., Chiesa A; Centro de Investigaciones Endocrinológicas 'Dr. César Bergadá' (CEDIE) -CONICET - FEI - División de Endocrinología, Hospital de Niños 'Ricardo Gutiérrez', Buenos Aires, Argentina. |
| المصدر: | Clinical endocrinology [Clin Endocrinol (Oxf)] 2021 Nov; Vol. 95 (5), pp. 760-765. Date of Electronic Publication: 2021 Jul 16. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Blackwell Publishing Country of Publication: England NLM ID: 0346653 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1365-2265 (Electronic) Linking ISSN: 03000664 NLM ISO Abbreviation: Clin Endocrinol (Oxf) Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: <2003->: Oxford : Blackwell Publishing Original Publication: Oxford, Blackwell Scientific Publications. |
| مواضيع طبية MeSH: | Hypocalcemia*/etiology , Hypocalcemia*/prevention & control , Hypoparathyroidism*/etiology , Hypoparathyroidism*/prevention & control, Calcium ; Child ; Humans ; Parathyroid Hormone ; Postoperative Complications/prevention & control ; Thyroidectomy/adverse effects |
| مستخلص: | Objetive: We followed our previously reported algorithm based on intra and postoperative parathyroid hormone (PTH) levels to predict postthyroidectomy hypoparathyroid hypocalcemia. The objective of the study was to assess if this strategy is useful and safe to reduce hypocalcemia, hospitalisation length and postsurgery calcium sampling. Design, Patients, Meassurements: We classified our series of 66 patients according to their risk of hypoparathyroidism based on PTH determinations. We treated high-risk patients with calcium and vitamin D1-25 supplementation and obtained routine daily calcium samples to control low-risk patients until 48 h postsurgery. We compared the outcomes and overall results of this new approach with those of a historical control group of patients with equivalent PTH measurements who were treated only if they presented hypocalcemia. Results: In the high-risk subgroup (n = 30), five patients had hypocalcemia within the first 24 h. Compared with the high-risk control subgroup, the incidence of hypocalcemia fell from 100% to 17% (p < .001), and the median hospitalisation length from 6 to 3 days (p < .001). In the low-risk subgroup (n = 36), 28 patients remained normocalcemic with significantly less calcium sampling (p < .001). Eight patients had hypocalcemia; seven of them required neck dissection, which was the only risk factor related to postsurgical hypoparathyroidism (RR: 2.1 [confidence interval 95%: 1.4-3.1]; p < .001). The overall incidence of hypocalcemia decreased by 58% in our patients compared to the control group. Conclusions: Assessing PTH levels to classify the risk of hypoparathyroidism and to initiate preventive therapy was an effective approach that improved the safety of our paediatric patients by reducing the incidence of hypocalcemia and the length of hospitalisation after thyroidectomy in paediatric patients. (© 2021 John Wiley & Sons Ltd.) |
| References: | Freire AV, Ropelato MG, Ballerini MG, et al. Predicting hypocalcemia after thyroidectomy in children. Surgery. 2014;156:130-136. Jiang W, Lee E, Newfield RS. The utility of intact parathyroid hormone level in managing hypocalcemia after thyroidectomy in children. Int J Pediatr Otorhinolaryngol. 2019;125:153-158. Overman RE, Jr., Hsieh LB, Menon R, Thomas IH, Bruch SW. 4-Hour postoperative PTH level predicts hypocalcemia after thyroidectomy in children. J Pediatr Surg. 2019;55:1265-1269. Patel NA, Bly RA, Adams S, et al. A clinical pathway for the postoperative management of hypocalcemia after pediatric thyroidectomy reduces blood draws. Int J Pediatr Otorhinolaryngol. 2018;105:132-137. Yu YR, Fallon SC, Carpenter JL, et al. Perioperative determinants of transient hypocalcemia after pediatric total thyroidectomy. J Pediatr Surg. 2017;52(5):684-688. Mathur A, Nagarajan N, Kahan S, Schneider EB, Zeiger MA. Association of parathyroid hormone level with postthyroidectomy hypocalcemia: a systematic review. JAMA Surg. 2018;153(1):69-76. Nordenstrom E, Bergenfelz A, Almquist M. Permanent hypoparathyroidism after total thyroidectomy in children: results from a national registry. World J Surg. 2018;42(9):2858-2863. Sosa JA, Tuggle CT, Wang TS, et al. Clinical and economic outcomes of thyroid and parathyroid surgery in children. J Clin Endocrinol Metab. 2008;93(8):3058-3065. Rivkees SA, Mazzaferri EL, Verburg FA, et al. The treatment of differentiated thyroid cancer in children: emphasis on surgical approach and radioactive iodine therapy. Endocr Rev. 2011;32(6):798-826. Papendieck P, Gruñeiro-Papendieck L, Venara M, et al. Differentiated thyroid cancer in children: prevalence and predictors in a large cohort with thyroid nodules followed prospectively. J Pediatr. 2015;167(1):199-201. Lombardi CP, Raffaelli M, Princi P, et al. Parathyroid hormone levels 4 hours after surgery do not accurately predict post-thyroidectomy hypocalcemia. Surgery. 2006;140(6):1016-1023. Raffaelli M, De Crea C, D'Amato G, et al. Post-thyroidectomy hypocalcemia is related to parathyroid dysfunction even in patients with normal parathyroid hormone concentrations early after surgery. Surgery. 2016;159(1):78-84. |
| فهرسة مساهمة: | Keywords: PTH; hypocalcemia; hypoparathyroidism; investigations & Rx; paediatric surgery; parathyroid; thyroid; thyroidectomy |
| المشرفين على المادة: | 0 (Parathyroid Hormone) SY7Q814VUP (Calcium) |
| تواريخ الأحداث: | Date Created: 20210705 Date Completed: 20211027 Latest Revision: 20211027 |
| رمز التحديث: | 20240628 |
| DOI: | 10.1111/cen.14552 |
| PMID: | 34219257 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1365-2265 |
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| DOI: | 10.1111/cen.14552 |