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

Abstract

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 6h post-operative parathyroid hormone (PTH) value. 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 6months postoperatively. Receiver operating characteristic (ROC) analysis was used to determine PTH value at 6h post-operative that was predictive of permanent hypoparathyroidism. Rates of permanent hypoparathyroidism reported are similar to those described in the literature with 12patients (10.9%) developing PH. In patients who developed PH, mean 6 h postoperative PTH was 5.12pg/mL. Mean 6h postoperative PTH level in those who did not develop PH was 31.34pg/mL (p<0.0001). The 6h post-operative PTH value predictive for PH was≤11.3pg/mL. PTH cutoff of≤11.3pg/mL had a sensitivity of 100%, specificity of 72.2%, positive predictive value (PPV) of 27.0%, and negative predictive value (NPV) of 100%. 6h postoperative PTH values were found to be predictive of permanent hypoparathyroidism in pediatric total thyroidectomy: a 6h postoperative PTH level of >11.3pg/mL excludes permanent hypoparathyroidism, but if PTH is≤11.3pg/mL at 6h, approximately 1/3 of patients may persist with permanent hypoparathyroidism.