ESPE Abstracts

Background:

Objective and hypotheses: Rate the frequency and structure of post-operative complications of thyroidectomy in children with nodular goiter.

Method: Twenty-seven children, 20 girls (14.5±3.64 years) and seven boys (14.68±4.09 years), which were performed thyroidectomy about multinodular goiter (n=23) and single-node goiter (n=4) from 2003 to 2015. Were evaluated complaints of patients, physical examination, biochemical blood test, electrocardiography data, fibrolaryngoscopy. As a biochemical marker of postoperative hypocalcaemia considered values of Ca²⁺ in blood serum: 1.03–0.9 mmol/l-mild; 0.8–0.9 mmol/l-moderate, <0.8 mmol/l-severe hypocalcaemia.

Results: The frequency of postoperative complications was 26% (7/27): five girls and two boys (14.63±3.4 years). Complications have presented hypocalcaemia, and vocal cord dysfunctions. Vocal cord dysfunctions were diagnosed in 4% (1/27) – girl 11.69 years old, healed after 3 months. Diagnosed with hypocalcaemia 22% (6/27) of patients (67% (4/6) girls, 16.11±1.23 years, and 33% (2/6) boys (13.12±6.53 years) were occurred in the first days after thyroidectomy, and demanded treatment. The asymptomatic hypocalcaemia has observed in 17% (1/6)-girl. The symptomatic hypocalcaemia – in 83% (5/6) patients, in this group of children 80% (4/5) of them had the QT interval prolongation in their electrocardiogram (Me0.02[0.01;0.035] s). In case of 67% (4/6) patients Ca²⁺ 0.96±0.04 mmol/l. In case of 33% (2/6) patients Ca²⁺ 0.84±0.03 mmol/l. In case of 17% (1/6) patients hypocalcaemia are persistent (more than 6 months), and in case of 83% (5/6) patient–transient character–duration of hypocalcaemia was observed from 7 to 30 days (Me 10[10; 18]days). Differences in volume of thyroid in patients with postoperative hypocalcaemia (Me16.99[9.84;24.63] cm³) and normocalcaemia (Me19.6[16.58;24.14] cm³) weren’t found (p>0,05). In addition, there wasn’t difference by rating of compression syndrome in the same treatment groups. So among the children with postoperative hypocalcaemia compression syndrome in 4/6 children, and among the children with normocalcaemia – in 10/21 children (P>0.05).

Conclusion: After thyroidectomy conducted over nodular goiter, vocal cord dysfunctions rare complication, hypocalcaemia occurs in every fifth child and is transient. In relation, it is necessary to search for predictors of postoperative hypocalcaemia in the preoperative stage during thyroidectomy, and find out the control of calcium and parathyroid hormone levels in blood serum in postoperative phase, starting from the first day.