Diagnostic and Therapeutic Strategies for Intraoperative and Postoperative Hypocalcemia in Pediatric Thyroidectomy Patients: A Single-Center Experience.

Background: The primary goals of surgical management in thyroid disorders are the treatment of malignancy, goiter, and thyrotoxicosis, while adhering to the principle of 'primum non nocere'. Hypocalcemia is among the most common complications, primarily resulting from inadvertent injury to the parathyroid glands.

Methods: A retrospective analysis of 2015-2023 records of Polish pediatric patients who underwent thyroid surgery.

Results: In our cohort of 217 children, 98 underwent hemithyroidectomy (HT) and 119 total thyroidectomy (TT). Postoperatively, 32-55% exhibited decreased total calcium, 8-44% had reduced ionized calcium, 9-27% demonstrated diminished parathyroid hormone, and 28-54% had elevated serum phosphate levels. These biochemical disturbances, along with malignancies detected in cytological and histopathological evaluations, the extent of surgery (TT and lateral neck lymph node dissection), and inadvertent parathyroid gland resection, were associated with prolonged hospitalization. Intraoperative parathyroid biopsies enabled parathyroid gland reimplantation in 7% and 21% of HT and TT cases, respectively.

Conclusions: The presence of malignant thyroid nodules and the consequent extensive surgical intervention substantially elevate the risk of postoperative hypoparathyroidism, prolonged hospitalization, and the requirement for calcium and 1-alpha-hydroxycholecalciferol supplementation. Intraoperative parathyroid biopsy enables gland reimplantation, reduces the risk of postoperative complications, and shortens hospital stays.