Evaluation of a protocol for pediatric thyroidectomy guidelines to diminish post-operative hypoparathyroidism medication use

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Introduction/Purpose: The purpose of this retrospective study is to compare patients who received early preventative treatment in patients identified at risk for hypocalcemia, while avoiding treatment in those patients found to be normocalcemic. PICOT: In pediatric patients who underwent a total thyroidectomy at Valley Children’s Hospital (VCH), can implementation of post-operative hypoparathyroidism disease management guidelines decrease the amount of prescribed calcium and calcitriol. Methods: Approval for study and waiving of informed consent was obtained from the Institutional Review Board at Valley Children’s Hospital (IRB No. HSC2297) and The University of Alabama in Tuscaloosa (IRB No. 20-07-3767). This was a retrospective chart review study. Medical records of all patients undergoing a Total Thyroidectomy at Valley Children's Hospital between August 2018 – January 2021 were reviewed (N = 41). Exclusion Criteria: Age >21 years old, history of chronic renal insufficiency, patients taking medications known to affect calcium or PTH levels, known pre-operative hypocalcemia, and those who already have hyperparathyroidism or hypoparathyroidism Statistical Analysis: Parathyroid hormone levels and calcium levels were recorded as well as if there was medication use. The Fisher- Freeman-Halton exact test was used to evaluate medication in 4 separate groups. Results: Of the 41 patients that underwent total thyroidectomies, 25 (61%) of the patients did not need medication. Medication use was separated in to 4 possible outcomes. The variable PTH ≤ 10 pg/mL + S. Calcium < 8 mg/dL (A), PTH ≤ 10 pg/mL + S. Calcium ≥ 8 mg/dL (B), PTH > 10 pg/mL + S. Calcium < 8 mg/dL (C), PTH > 10 pg/mL + S. Calcium ≥ 8 mg/dL (D). In B and D group variables it was proven to have a statistical significance where p=

post-operative hypoparathyroidism, thyroidectomy, hypocalcemia, calcium, PTH