Introduction
Along with the recurrent laryngeal nerve paralysis and bleeding,
postoperative hypocalcemia is the major and most frequent complication
that occurs after thyroid surgery1. Commonly it arises
following removal or insult to the parathyroid glands at neck surgery2-6. Hypoparathyroidism is defined by a decrease in
serum PTH and calcium levels: it may occur as a transient form (TtHP),
with progressive normalization within six months from surgical
treatment, or permanent (PtHP), whenever the patient continues to
require replacement therapy 7,8. Numerous reports have
attempted to correlate the incidence of post surgical complications with
the type of thyroid disease associated, positive family history of
thyroid cancer, gender of the patient, type of operation, cervical lymph
nodes involvement, surgical expertise and surgical timing6, 9-13. The identification of fewer than two
parathyroid glands during thyroidectomy is also associated with the
development of hypocalcemia 14. Others have
investigated the possible link between the development of transient
hypocalcemia and low levels of preoperative vitamin D associated with
low postoperative parathyroid hormone (PTH) 15-22.
Another biochemical parameter which has been correlated with transient
hypocalcemia is the post-operative serum magnesium concentration,
independently of the serum calcium levels 23-26. The
calcium level less than 1.88 mmol/l or lower after 24h from thyroid
surgery has been reported as predictive for the development of permanent
hypocalcemia 27-32. The risk factors identified by the
scientific community are different, depending on TtHP or PtHP and are
currently a matter of debate. In the present study the main end-point
was to analyze, in a pediatric population following thyroid surgery,
rate and factors associated with the development of TtHP or PtHP.