Outpatient Parathyroidectomy in the Pediatric Population: An 18-year Experience
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Read the article on jpedsurg.org ↗Article · Feb 2021 · 1 min read
In brief
In brief
Eighteen-year single-surgeon series demonstrates that outpatient parathyroidectomy is safe and effective in pediatric patients with primary hyperparathyroidism, with low complication rates and no unplanned admissions. Study included 19 patients aged 8-18 years with both single adenomas and multigland disease, achieving excellent biochemical outcomes.
Written by the GCMD Library team from the article.
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.