Surgical management of pediatric Graves’ disease: an effective definitive treatment

Peroni, Elena; Angiolini, Maria Rachele; Vigone, Maria Cristina; Mari, Gilberto; Chiumello, G; Beretta, Edoardo; Weber, Giovanna

doi:10.1007/s00383-012-3095-5

Cited by 29 publications

(15 citation statements)

References 23 publications

(21 reference statements)

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“…Considering these data, if local pediatric thyroid surgery expertise is unavailable, referral of a child with GD to a high-volume, thyroid surgery center with pediatric experience should be considered [124,125]. Very low complication rates for children undergoing the thyroidectomies for GD have been reported with this type of multidisciplinary model [119,124].…”

Section: Surgerymentioning

confidence: 99%

Pediatric Graves’ disease: management in the post-propylthiouracil Era

Rivkees

2014

Int J Pediatr Endocrinol

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The most prevalent cause of thyrotoxicosis in children is Graves’ disease (GD), and remission occurs only in a modest proportion of patients. Thus most pediatric patients with GD will need treatment with radioactive iodine (RAI; 131I) or surgical thyroidectomy. When antithyroid drugs (ATDs) are prescribed, only methimazole (MMI) should be administered, as PTU is associated with an unacceptable risk of severe liver injury. If remission does not occur following ATD therapy, 131I or surgery should be contemplated. When 131I is administered, dosages should be greater than 150 uCi/gm of thyroid tissue, with higher dosages needed for large glands. Considering that there will be low-level whole body radiation exposure associated with 131I, this treatment should be avoided in young children. When surgery is performed near total or total-thyroidectomy is the recommended procedure. Complications for thyroidectomy in children are considerably higher than in adults, thus an experienced thyroid surgeon is needed when children are operated on. Most importantly, the care of children with GD can be complicated and requires physicians with expertise in the area.

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Section: Surgerymentioning

confidence: 99%

Pediatric Graves’ disease: management in the post-propylthiouracil Era

Rivkees

2014

Int J Pediatr Endocrinol

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“…Table 1 also shows in which studies thyroidectomies were performed by a high-volume or a low-volume surgeon. Eight studies reported that the thyroidectomy was performed by a high-volume surgeon [10, 11, 13-15, 21, 29, 31]. In the study by Cohen et al [23], surgery was performed by a low-volume surgeon.…”

Section: Resultsmentioning

confidence: 99%

“…The remaining 13 studies did not report whether thyroidectomies were performed by a low- or a high-volume surgeon [12, 16-20, 22, 24-26, 28, 30]. In 3 studies, thyroidectomies were performed by a pediatric surgeon [14, 21, 22], in 3 studies by an endocrine surgeon [11, 26, 29], and in 4 by both pediatric and adult surgeons [12, 18, 19, 31]. In the other studies, the surgeon’s background was not specified.…”

Section: Resultsmentioning

confidence: 99%

Thyroidectomy in Pediatric Patients with Graves’ Disease: A Systematic Review of Postoperative Morbidity

Zaat¹,

Derikx²,

Zwaveling-Soonawala³

et al. 2020

Eur Thyroid J

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Background: Graves’ disease (GD) is the most common cause of hyperthyroidism. In children, the overall relapse frequency after treatment with antithyroid drugs is high. Therefore, many pediatric GD patients eventually require thyroidectomy as definitive treatment. However, the postoperative complications of thyroidectomy in pediatric GD patients are poorly reported. Objective: To identify the frequency of short- and long-term postoperative morbidities after thyroidectomy in pediatric GD patients. Methods: A systematic review of the literature (PubMed and Embase) was performed to identify studies reporting short- and long-term postoperative morbidities after thyroidectomy in pediatric GD patients according to the PRISMA guidelines. Results: Twenty-two mainly retrospective cohort studies were included in this review evaluating short- and long-term morbidities in 1,424 children and adolescents. The frequency of transient hypocalcemia was 22.2% (269/1,210), with a range of 5.0–50.0%. The frequency of permanent hypocalcemia was 2.5% (36/1,424), with a range of 0–20.0%. Two studies reported high frequencies of permanent hypocalcemia, 20.0 (6/30) and 17.4% (9/52), respectively. The 20% frequency could be explained by low-volume surgeons in poorly controlled GD patients. Only 21 cases of permanent hypocalcemia were reported in the 1,342 patients included in the other 20 studies (1.6%). Transient and permanent recurrent laryngeal nerve injury were reported less frequently, with frequencies between 0–20.0 and 0–7.1%, respectively. Infection, hemorrhage/hematoma, and keloid development were only rarely reported as postoperative complications. Conclusion: The results of this systematic review suggest that thyroidectomy is a safe treatment option for pediatric GD patients. The minority of patients will experience transient and benign morbidities, with hypocalcemia being the most common transient postoperative morbidity. Permanent postoperative morbidities are relatively rare.

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“…We were able to accrue this many patients over a relatively short time period because of our institution’s high utilization of thyroidectomy as a first line treatment for Graves’ disease. Peroni, et al found similar low rates of complications for a cohort of 27 children who underwent thyroidectomy for Graves’ disease between 1991 and 2009 [19]. Breuer, et al reported on a cohort of 30 children between 2002 and 2010, and found rates of temporary hypocalcemia were higher but long-term outcomes were equivalent in children compared to adults [22].…”

Section: Discussionmentioning

confidence: 99%

Thyroidectomy for Graves' disease in children: Indications and complications

Elfenbein

Katz

Chen

et al. 2016

Journal of Pediatric Surgery

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Structured Abstract Background The utilization of thyroidectomy for Graves’ disease remains controversial; we aim to evaluate the indications for and complications of thyroidectomy for Graves’ in children. Methods A retrospective analysis was performed on all Graves’ patients who underwent thyroidectomy from 2009–2013 at a high volume academic center. Pediatric patients were < 18 years old, and a comparative analysis of indications for surgery and complications was performed. Results 167 patients underwent thyroidectomy: 31 pediatric patients and 136 adults. Failure of antithyroid medications was the indication for surgery in 55% of the children vs 36% of adults (p=0.05). Mean duration of medications prior to surgery was similar. No children had failed RAI therapy prior to surgery, but 12.5% of the adult population had (p=0.04). Surgical outcomes were similar. Conclusion Clinicians may be more likely to refer children who fail medical treatment to surgery over RAI. Thyroidectomy at a high volume hospital should be discussed as a treatment option for children with Graves’.

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Surgical management of pediatric Graves’ disease: an effective definitive treatment

Abstract: Surgical therapy for pediatric GD performed by experienced thyroid surgeons is a safe, definitive and cost-effective treatment.

Cited by 29 publications

References 23 publications

Pediatric Graves’ disease: management in the post-propylthiouracil Era

Pediatric Graves’ disease: management in the post-propylthiouracil Era

Thyroidectomy in Pediatric Patients with Graves’ Disease: A Systematic Review of Postoperative Morbidity

Thyroidectomy for Graves' disease in children: Indications and complications

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