Perioperative outcomes in children with Hashimoto's thyroiditis undergoing total thyroidectomy

Inbal Hazkani*, Evan Edwards, Eli Stein, John Maddalozzo, Douglas R. Johnston, Jill Samis, Jami Josefson, Jeffrey Rastatter

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Hashimoto's thyroiditis (HT) affects 1–2 % of the pediatric population. In adults with HT, thyroidectomy is considered challenging and prone to postoperative complications due to the chronic inflammatory process. However, the complications of thyroidectomy among children with HT have not been established. The objective of our study was to evaluate whether children with HT undergoing total thyroidectomy for presumed thyroid cancer have higher complication rates than children without HT. Methods: A retrospective cohort study of children who underwent total thyroidectomy by high-volume pediatric otolaryngologists between 2014 and 2021. Results: 111 patients met inclusion criteria, 15 of these were diagnosed with HT preoperatively. Operative time and length of admission were similar among the groups. Postoperatively, patients with HT were more likely to have low levels of parathyroid hormone (60 % vs 26 %, p = 0.014) and transient hypocalcemia compared to non-HT patients, present with symptomatic hypocalcemia (67 % vs 27 %, p = 0.006), demonstrate EKG changes (20 % vs 6.3 %, p = 0.035) within 24 h of surgery, and to require both oral and intravenous calcium supplements (80 % vs 35 %, p = 0.001 and 60 % vs 22 % p = 0.004 respectively). Persistent hypocalcemia at 6 months follow-up, and recurrent laryngeal nerve paralysis rates were similar between groups. Parathyroid tissue was found in the thyroid specimen of 9 (60 %) HT patients vs 34 (35 %) non-HT patients (p = 0.069). Conclusions: The risk of permanent complications among children with HT following thyroidectomy is low. However, patients with HT are more likely to develop symptomatic transient hypocalcemia and to require oral and intravenous calcium supplements in the immediate post-operative period compared to non-HT patients. Tailoring a perioperative treatment protocol to optimize calcium levels may be considered for children with HT.

Original languageEnglish (US)
Article number103785
JournalAmerican Journal of Otolaryngology - Head and Neck Medicine and Surgery
Issue number2
StatePublished - Mar 1 2023


  • Complications
  • Hashimoto's thyroiditis
  • Hypocalcemia
  • Hypoparathyroidism
  • Pediatric thyroidectomy

ASJC Scopus subject areas

  • Otorhinolaryngology


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