Hypocalcemia prevention and management after thyroidectomy in children: A systematic review

Ankitha Radakrishnan, Abhita T. Reddy, Prarthana Dalal, Jeffrey C. Rastatter, Jami L. Josefson, Jill H. Samis, Molly Beestrum, Yao Tian, Mehul V. Raval*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Hypocalcemia is the most common complication following thyroidectomy in children. Guidelines to manage post-thyroidectomy hypocalcemia are available for adults, but not children. The objective of this review was to identify practices related to hypocalcemia prevention and management in pediatric patients. Methods: We identified studies examining the prevention and management of hypocalcemia in pediatric patients post-thyroidectomy within PubMed, EMBASE, Web of Science and Cochrane databases. Three independent reviewers screened citations and reviewed full-text papers. Results: A total of 15 studies were included, representing 1552 patients. The overall study quality was weak with lack of randomization and inconsistent outcome reporting. The pooled incidence of hypocalcemia from the 15 studies was 35.5% for transient hypocalcemia and 4.2% for permanent hypocalcemia. All studies discussed post-operative hypocalcemia treatment, with most patients requiring admission for intra-venous calcium therapy. One study described a protocol discharging asymptomatic patients on calcitriol and calcium. Three studies discussed preoperative calcium supplementation in patients at risk of hypocalcemia. No studies examined routine use of calcium and/or vitamin D supplementation to prevent post-operative hypocalcemia. Conclusion: A significant number of children undergoing thyroidectomy develop hypocalcemia. Despite this high incidence, our systematic review demonstrates significant practice variation surrounding post-thyroidectomy hypocalcemia prevention and management in children. Level of Evidence: III (systematic review of studies of which some were case–control studies (III) and some were case series (IV)).

Original languageEnglish (US)
Pages (from-to)526-533
Number of pages8
JournalJournal of pediatric surgery
Volume56
Issue number3
DOIs
StatePublished - Mar 2021

Keywords

  • Hypocalcemia
  • Hypoparathyroidism
  • Outcomes
  • Pediatric population
  • Thyroidectomy

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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