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Thyroidectomy in Pediatric Patients with Graves’ Disease: A Systematic Review of Postoperative Morbidity
European Thyroid Journal ( IF 4.7 ) Pub Date : 2020-11-17 , DOI: 10.1159/000511345
Annabel S Zaat 1 , Joep P M Derikx 2 , Nitash Zwaveling-Soonawala 1 , A S Paul van Trotsenburg 1 , Christiaan F Mooij 1
Affiliation  

Background: Graves’ disease (GD) is the most common cause of hyperthyroidism. In children, the overall relapse frequency after treatment with antithyroid drugs is high. Therefore, many pediatric GD patients eventually require thyroidectomy as definitive treatment. However, the postoperative complications of thyroidectomy in pediatric GD patients are poorly reported. Objective: To identify the frequency of short- and long-term postoperative morbidities after thyroidectomy in pediatric GD patients. Methods: A systematic review of the literature (PubMed and Embase) was performed to identify studies reporting short- and long-term postoperative morbidities after thyroidectomy in pediatric GD patients according to the PRISMA guidelines. Results: Twenty-two mainly retrospective cohort studies were included in this review evaluating short- and long-term morbidities in 1,424 children and adolescents. The frequency of transient hypocalcemia was 22.2% (269/1,210), with a range of 5.0–50.0%. The frequency of permanent hypocalcemia was 2.5% (36/1,424), with a range of 0–20.0%. Two studies reported high frequencies of permanent hypocalcemia, 20.0 (6/30) and 17.4% (9/52), respectively. The 20% frequency could be explained by low-volume surgeons in poorly controlled GD patients. Only 21 cases of permanent hypocalcemia were reported in the 1,342 patients included in the other 20 studies (1.6%). Transient and permanent recurrent laryngeal nerve injury were reported less frequently, with frequencies between 0–20.0 and 0–7.1%, respectively. Infection, hemorrhage/hematoma, and keloid development were only rarely reported as postoperative complications. Conclusion: The results of this systematic review suggest that thyroidectomy is a safe treatment option for pediatric GD patients. The minority of patients will experience transient and benign morbidities, with hypocalcemia being the most common transient postoperative morbidity. Permanent postoperative morbidities are relatively rare.
Eur Thyroid J


中文翻译:

Graves 病儿科患者的甲状腺切除术:术后发病率的系统评价

背景:格雷夫斯病 (GD) 是甲状腺功能亢进的最常见原因。在儿童中,抗甲状腺药物治疗后的总体复发率很高。因此,许多儿童 GD 患者最终需要甲状腺切除术作为最终治疗。然而,关于儿童 GD 患者甲状腺切除术后并发症的报道很少。目的:确定儿童 GD 患者甲状腺切除术后短期和长期术后并发症的发生率。方法:对文献(PubMed 和 Embase)进行系统回顾,以确定根据 PRISMA 指南报告儿童 GD 患者甲状腺切除术后短期和长期术后并发症的研究。结果:本综述纳入了 22 项主要回顾性队列研究,评估了 1,424 名儿童和青少年的短期和长期发病率。短暂性低钙血症的发生率为 22.2% (269/1,210),范围为 5.0-50.0%。永久性低钙血症的发生率为 2.5% (36/1,424),范围为 0-20.0%。两项研究报告了永久性低钙血症的高频率,分别为 20.0 (6/30) 和 17.4% (9/52)。20% 的频率可以用控制不佳的 GD 患者的小手术量外科医生来解释。在其他 20 项研究中纳入的 1,342 名患者中,仅报告了 21 例永久性低钙血症(1.6%)。短暂性和永久性喉返神经损伤的报道较少,频率分别在 0-20.0 和 0-7.1% 之间。感染、出血/血肿、结论:本系统评价的结果表明,甲状腺切除术是儿科 GD 患者的安全治疗选择。少数患者会出现短暂和良性的并发症,其中低钙血症是最常见的短暂性术后并发症。永久性术后并发症相对少见。
欧洲甲状腺杂志
更新日期:2020-11-17
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