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
Open accessAbstract
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.
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Thyroidectomy is an effective treatment for GD.
“Thyroidectomy is an effective treatment for GD, but it is associated with a higher complication rate in children than in adults (316)(317)(318).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [318]
Thyroidectomy is associated with a higher complication rate in children than in adults.
“Thyroidectomy is an effective treatment for GD, but it is associated with a higher complication rate in children than in adults (316)(317)(318).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [318]
Postoperatively, younger children also appear to be at higher risk for transient hypoparathyroidism than adolescents or adults.
“Postoperatively, younger children also appear to be at higher risk for transient hypoparathyroidism than adolescents or adults (316,318).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [318]
Surgical complication rates are higher in children than in adults, with higher rates in younger than in older children.
“Surgical complication rates are higher in children than in adults, with higher rates in younger than in older children (316,318).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [318]
Reports of institutional experience show low complication rates at high-volume centers.
“Further support for the notion that thyroidectomy for GD in children should be performed by experienced thyroid surgeons comes from reports of institutional experience showing low complication rates at high-volume centers (318,364).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [318]
Data from one center suggest that if calcitriol is started 3 days before surgery (0.25 or 0.5 μg, twice daily), the need for postoperative calcium infusions is markedly reduced, leading to reduction in the length of stay.
“Data from one center suggest that if calcitriol is started 3 days before surgery (0.25 or 0.5 lg, twice daily), the need for postoperative calcium infusions is markedly reduced, leading to reduction in the length of stay (318).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [318]
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- Authors
- Breuer, C. K., Solomon, D., Donovan, P., Rivkees, S. A., & Udelsman, R.
- Affiliations
- Yale University (US)
- Corresponding author
- Udelsman, Robert
- Venue
- International Journal of Pediatric Endocrinology
- Published
- 2013-01-25
- Volume
- 2013
- Issue
- 1
- Pages
- 1-1
- ISSN
- 1687-9848 (ISSN-L)
- 1687-9856
- PMC
- PMC3574836
- OpenAlex
- W2110496443
- Cited by
- 49
- References
- 19
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 4 · 2023: 2 · 2022: 8 · 2021: 5 · 2020: 5 · 2019: 5 · 2018: 6 · 2016: 4 · 2015: 4 · 2014: 4
- FWCI
- 3.95
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of Pediatric Endocrinology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- U.S. Food and Drug Administration (R01FD003707)
- Topics
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Keywords
- Graves' disease, total thyroidectomy, pediatric thyroid surgery, age differences in surgical outcomes, postoperative hypocalcemia, recurrent laryngeal nerve palsy, postoperative hematoma, operative time, thyroidectomy complications, length of hospital stay, children versus adults
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