Predictive value of 6 h postoperative parathyroid hormone level on permanent hypoparathyroidism in pediatric total thyroidectomy: a pilot study

Olivia A. Keane; Shasha Bai; Kristina Cossen; Briana C. Patterson; Kara K. Prickett; Kurt F. Heiss; Matthew T. Santore

doi:10.1515/jpem-2022-0633

Article

Predictive value of 6 h postoperative parathyroid hormone level on permanent hypoparathyroidism in pediatric total thyroidectomy: a pilot study

Olivia A. Keane , Shasha Bai , Kristina Cossen , Briana C. Patterson , Kara K. Prickett , Kurt F. Heiss and Matthew T. Santore

Published/Copyright: January 11, 2023

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From the journal Journal of Pediatric Endocrinology and Metabolism Volume 36 Issue 3

Abstract

Objectives

Transient hypocalcemia is a common complication after pediatric total thyroidectomy, while permanent hypoparathyroidism (PH) is relatively uncommon. To date there is no model to predict which patients will develop PH based on post-operative makers. We aim to identify pediatric patients who are at high risk of PH following thyroidectomy based on 6 h post-operative parathyroid hormone (PTH) value.

Methods

A retrospective review of 122 pediatric patients undergoing total thyroidectomy between 2016 and 2022 following implementation of a multidisciplinary team was performed. Outcome of interest was permanent hypoparathyroidism, defined as need for calcium supplementation at 6 months postoperatively. Receiver operating characteristic (ROC) analysis was used to determine PTH value at 6 h post-operative that was predictive of permanent hypoparathyroidism.

Results

Rates of permanent hypoparathyroidism reported are similar to those described in the literature with 12 patients (10.9%) developing PH. In patients who developed PH, mean 6 h postoperative PTH was 5.12 pg/mL. Mean 6 h postoperative PTH level in those who did not develop PH was 31.34 pg/mL (p<0.0001). The 6 h post-operative PTH value predictive for PH was ≤11.3 pg/mL. PTH cutoff of ≤11.3 pg/mL had a sensitivity of 100%, specificity of 72.2%, positive predictive value (PPV) of 27.0%, and negative predictive value (NPV) of 100%.

Conclusions

6 h postoperative PTH values were found to be predictive of permanent hypoparathyroidism in pediatric total thyroidectomy: a 6 h postoperative PTH level of >11.3 pg/mL excludes permanent hypoparathyroidism, but if PTH is ≤11.3 pg/mL at 6 h, approximately 1/3 of patients may persist with permanent hypoparathyroidism.

Keywords: hypocalcemia; hypoparathyroidism; parathyroid hormone; pediatric thyroidectomy; thyroidectomy

Corresponding author: Olivia A. Keane, MD, Department of Surgery, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322, USA, Phone: 804-938-9439, E-mail: okeane@emory.edu

Acknowledgments

We gratefully acknowledge Dr. Shasha Bai and the Emory Pediatric Biostatistics Core team for their assistance with data analysis. We also acknowledge the CHOA Multidisciplinary Thyroid Team for their support and assistance with editing.

Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Not applicable.
Ethical approval: The study was approved by Children’s Healthcare of Atlanta’s Institutional Review Board (IRB).

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Received: 2022-10-19

Accepted: 2022-12-30

Published Online: 2023-01-11

Published in Print: 2023-03-28

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Articles in the same Issue

https://doi.org/10.1515/jpem-2022-0633

Keywords for this article

hypocalcemia; hypoparathyroidism; parathyroid hormone; pediatric thyroidectomy; thyroidectomy