B. C. James1, M. Landman3, R. Danforth2, W. Bennett4 1Indiana University,Endocrine Surgery/Surgery/School Of Medicine,Indianapolis, IN, USA 2Indiana University,Plastic Surgery/Surgery/School Of Medicine,Indianapolis, IN, USA 3Indiana University,Pediatric Surgery/Surgery/School Of Medicine,Indianapolis, IN, USA 4Indiana University,Pediaric Gastroenterology/Pediatrics/School Of Medicine,Indianapolis, IN, USA
Introduction:
Graves’ disease is the leading cause of hyperthyroidism in pediatric patients and can be a significant source of educational, social, and physiologic disturbances. Children with Graves’ disease unfortunately face lower rates of remission and higher rates of recurrence than their adult counterparts with medical treatment. Whether thyroidectomy or radioiodine therapy is the treatment of choice in children remains controversial, and there is a lack of multi-center data regarding the demographics, outcomes, and complications of total thyroidectomy in children. We aim to evaluate outcomes in the surgical treatment of Graves’ disease in the pediatric population.
Methods:
A retrospective analysis was performed using the Pediatric Health Information System (PHIS), an administrative database of from over 46 children’s hospitals with encounters from 2004 to present. All pediatric patients in the database with the diagnosis of Graves’ disease (ICD-9 242.XX) who underwent total thyroidectomy (ICD-9-CM 06.4) were included. The primary outcomes examined included: length of stay, hypocalcemia or hypoparathyroidism, and vocal cord paralysis. Logistic regression was performed to determine which hospital and patient factors contributed to these outcomes.
Results:
The study cohort included 883 pediatric patients who underwent total thyroidectomy for the treatment of Graves’ Disease. The mean age was 13.5 years, 80.3% were female, and the majority were white (62.2%). Eleven patients (1.2%) developed vocal cord paralysis postoperatively and 231 (26%) patients were diagnosed with hypocalcemia. Infants had an increased risk of hypoparathyroidism (OR 2.1, p=0.004). Additionally, infants (OR 2.1, p=0.002) and children ages 2-7 years (OR 1.1, p=0.009) had longer hospitalizations than preadolescents and adolescents. Hospital volume below the highest quartile was also associated with length of stay greater than 48 hours (OR 1.15, p=0.002).
Conclusions:
Our study supports the surgical treatment of Graves’ Disease in the pediatric population, since we report similar rates of hypocalcemia and nerve injury to the adult population. Further research should be conducted to compare thyroidectomy to radioiodine therapy.