Effect of patient Age on surgical outcomes for Graves’ disease: a case–control study of 100 consecutive patients at a high volume thyroid surgical center

International Journal of Pediatric Endocrinology

Robert Udelsman¹  Scott A Rivkees¹  Patricia Donovan²  Daniel Solomon²  Christopher K Breuer¹ 

[1] Yale Pediatric Thyroid Center, Yale University School of Medicine, New Haven, CT, US;Department of Surgery, Yale University School of Medicine, New Haven, CT, US

关键词: Adult;    Child;    Pediatric;    Thyroid;    Graves’s disease;    Thyroidectomy;    Hyperthyroidism;   

Others  :  812676
DOI  :  10.1186/1687-9856-2013-1

 received in 2012-12-03, accepted in 2012-12-03,  发布年份 2013

【 摘 要 】

Objective

To compare outcomes between children (<18 yrs) and adults undergoing total thyroidectomy for Graves’ disease (GD) at a high volume, multidisciplinary thyroid center.

Summary of background data

Reported complication rates for children undergoing surgery for Graves’ disease are worse than for adults.

Methods

100 consecutive patients (32 children; 68 adults) who underwent total thyroidectomy for Graves’ disease (GD) by a high-volume endocrine surgery team from were compared.

Results

The mean patient age was 9.7 yrs (range 3.4-17.9 yrs) in children versus 44.9 yrs (range 18.4-84.2 yrs) in adults. Operative times were longer in children (2.18 ± 0.08 hrs) than in adults (1.66 ± 0.03 hrs) (p = 0.003). Pediatric thyroid specimens averaged 38.6.0 ± 8.9 gm (range: 9–293 gm) and adult thyroid specimens averaged 48.0 ± 6.4 gm (range: 6.6-203 gm) (p = 0.34). Thyroid to body weight ratios were greater in children (0.94 ± 0.11 gm/kg) than adults (0.67 ± 0.8 gm/kg) (p = 0.05). In all patients, the hyperthyroid state resolved after surgery. There was no operative mortality, recurrence, or permanent hypoparathyroidism. Transient post-operative hypocalcemia requiring calcium infusion was greater in children than adults (6/32 vs. 1/68; p = 0.004). Transient recurrent laryngeal nerve dysfunction occurred in two children and in no adults (p = 0.32). Postoperative hematoma occurred in two adults and in no children (p = 0.46). The length of stay was longer for children (1.41 ± 0.12 days) than for adults (1.03 ±0.03 days) (p = 0.004).

Conclusion

Surgical management of GD is technically more challenging in children as evidenced by longer operative times. Whereas temporary hypocalcemia occurs more commonly in children than adults, the risks of major complications including disease recurrence, permanent hypoparathyroidism, recurrent laryngeal nerve injury, or neck hematoma were indistinguishable. These data suggest that excellent and equivalent outcomes can be achieved for GD surgery in children and adults when care is rendered by a high volume, endocrine surgery team.

【 授权许可】

   
2013 Breuer et al.; licensee BioMed Central Ltd.

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