儿童分化型甲状腺癌手术范围与术后早期低钙负担的关系:单中心病例回顾OA

OBJECTIVE To investigate the association of surgical extent with early postoperative hypocalcemia burden and parathyroid hormone(PTH)changes in children with differentiated thyroid carcinoma(DTC).METHODS We retrospectively reviewed the clinical data of children with DTC who underwent surgery at Beijing Children's Hospital,Capital Medical University,between April 2016 and March 2025.Patients were categorized into the total thyroidectomy group and the lobectomy plus isthmusectomy group.The primary outcomes were serum calcium and PTH levels on postoperative day 1.Secondary outcomes included hypocalcemia on postoperative day 1,serum calcium and PTH levels at postoperative month 1,documented hoarseness or voice changes,recurrence,and subgroup findings.Between-group comparisons were performed using the Mann-Whitney U test,Fisher's exact test,or Pearson's chi-square test.Multivariable logistic regression was used to evaluate the association between surgical extent and hypocalcemia-related outcomes on postoperative day 1.RESULTS Fifty-seven children were included;27 underwent total thyroidectomy and 30 underwent lobectomy plus isthmusectomy.The median follow-up was 34(23,58)months.Compared with the lobectomy plus isthmusectomy group,the total thyroidectomy group had lower serum calcium[2.14(2.04,2.23)mmol/L vs.2.29(2.25,2.38)mmol/L,P<0.001]and PTH[11.20(1.40,28.05)pg/ml vs.32.05(25.03,46.88)pg/ml,P<0.001]on postoperative day 1.Serum calcium[2.23(2.03,2.31)mmol/L vs.2.44(2.33,2.49)mmol/L,P=0.003]and PTH[27.90(12.60,32.80)pg/ml vs.38.05(33.35,47.12)pg/ml,P=0.021]at postoperative month 1 were also lower in the total thyroidectomy group.Serum calcium<2.11 mmol/L on postoperative day 1 was more frequent after total thyroidectomy[44.4%(12/27)vs.3.7%(1/27),P<0.001],as was PTH<15 pg/ml[63.0%(17/27)vs.7.7%(2/26),P<0.001].Documented hoarseness or voice changes occurred in 28.0%(7/25)and 10.0%(3/30)of patients,respectively(P=0.158).The direction of between-group differences in early postoperative calcium and PTH was consistent in the N0 subgroup and in the N0 subgroup without lateral neck dissection.After adjustment for age,maximum tumor diameter,and N category,total thyroidectomy was associated with serum calcium<2.11 mmol/L(OR=28.36,95%CI:2.41-333.91,P=0.008)and PTH<15 pg/ml(OR=21.88,95%CI:2.67-179.47,P=0.004)on postoperative day 1.One recurrence was observed in each group during follow-up.CONCLUSION In this cohort,lobectomy plus isthmusectomy was associated with a lower early postoperative hypocalcemia burden and better preservation of parathyroid function than total thyroidectomy.In carefully selected children with a low tumor burden,preservation of thyroid tissue may confer perioperative advantages;longer follow-up is needed to evaluate oncologic outcomes.