Faculty Collaboration Database

Outpatient parathyroidectomy in the pediatric population: An 18-year experience. J Pediatr Surg 2022 Mar;57(3):410-413

Date

03/23/2021

Pubmed ID

33745744

DOI

10.1016/j.jpedsurg.2021.02.057

Scopus ID

2-s2.0-85102818918 (requires institutional sign-in at Scopus site)   3 Citations

Abstract

BACKGROUND: Parathyroidectomy for primary hyperparathyroidism (pHPT) is safely performed in the outpatient setting in the adult population. However, concern that children and adolescents have higher complication rates and are unable to recognize and communicate symptoms of hypocalcemia has limited same-day discharges in the pediatric population.

METHODS: Nineteen patients aged 8-18 years (14.1 ± 0.7) underwent outpatient parathyroidectomy for pHPT by a single high-volume endocrine surgeon from 2002-2020. Patient demographics, disease, operations, and complications were reviewed.

RESULTS: Sixteen of 19 patients were symptomatic with fatigue (62.5%), joint pain (37.5%) and nephrolithiasis (18.7%) most common. Mean preoperative Ca and PTH were 11.7 ± 0.3 mg/dL and 102.3 ± 11.8pg/mL, respectively. Ten of 19 had a single adenoma and 9 had multigland hyperplasia including one MEN1 and one MEN2A patient. We performed 11 four-gland explorations, 8 unilateral parathyroidectomies; including 9 transcervical thymectomies, 1 total thyroidectomy, and 1 bilateral central neck dissection. Mean 6-month postoperative Ca and PTH levels were 9.5 ± 0.3 mg/dL (range 7.3-10.3) and 29±5.0pg/mL (range 6.3-77), respectively. One patient developed permanent hypoparathyroidism and 1 had temporary hypocalcemia. No temporary or permanent hoarseness, unplanned same-day admission, wound complications, or Emergency Department visits occurred.

CONCLUSION: Outpatient parathyroidectomy can be safely and effectively performed in pediatric patients with primary HPT.

LEVEL OF EVIDENCE: Treatment Study, Level III.

Author List

Ramonell KM, Fazendin J, Lovell K, Iyer P, Chen H, Lindeman B, Dream S

Authors

Sophie Y. Dream MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Pallavi Iyer MD Chief, Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Child
Humans
Hypocalcemia
Hypoparathyroidism
Outpatients
Parathyroidectomy
Retrospective Studies
Thymectomy