Thyroid surgery in 103 children in a single institution from 2000-2014

Abstract

BACKGROUND: Data on thyroid surgery in children are scarce. OBJECTIVE: Analyze outcome data on thyroid surgery in a pediatric population. DESIGN: Medical record review. SETTING: Tertiary health care institution. PATIENTS AND METHODS: We collected demographic and clinical data on patients 18 years or younger who had thyroid surgery in the period 2000 to 2014. Descriptive data are presented. MAIN OUTCOME MEASURES: Indications for thyroidectomy, thyroid pathology, complications, length of stay, and radioactive iodine treatment and recurrences. SAMPLE SIZE: 103. RESULTS: Of 103 patients who underwent 112 thyroidectomy procedures, 80 (78%) were females and the mean age at operation was 13.2 years. and 17 (16%) were associated with multiple endocrine neoplasia type 2. There was no history of radiation exposure. Eighty-one patients (78%) had fine needle aspiration (FNA) which correlated with the final histopathology in 94% of cases. Sixty-six patients (64%) had malignant cancer (61 papillary), 44 (74.6%) of 59 patients who had neck dissection had lymph node metastasis and 7 (11%) had distant metastases to the lung. Procedures included total thyroidectomy (50%), hemithyroidectomy (17%), completion (31%), and subtotal thyroidectomy (2%). Twenty-three patients (22%) developed hypocalcemia (3 permanent) and 6 (5.8%) had unilateral recurrent laryngeal nerve injury (3 permanent). Patients were followed up for a mean duration of 71.7 months (median 60 months). Of 66 patients with thyroid cancer, 43 (65%) received radioactive iodine, and 10 (15%) had recurrence. CONCLUSION: Malignancy is the commonest indication for thyroid surgery in children and FNA is highly diagnostic. Hypocalcemia and recurrent laryngeal nerve injury are significant complications. The recurrence rate in thyroid cancer is 15%. LIMITATIONS: Retrospective. CONFLICT OF INTEREST: None.

Incidental Parathyroidectomy Among Pediatric Patients Undergoing Thyroid Surgery

“…A recent pediatric study found that malignancy significantly increased the risk of permanent hypoparathyroidism, while there was no significantly increased risk with Graves' disease 11 . Conversely, another study found that Graves' disease did increase the risk for hypocalcemia 4,36 . Of note, there is a relatively low rate of thyroidectomy for Graves' disease in our study, limiting the power to assess contribution to outcome.…”

“…The risk of permanent hypoparathyroidism ranges from 0.6% to 7.3% 4,11,30,36,49,50 . Our experience suggested a higher rate.…”

Surgical treatment of pediatric and adolescent papillary thyroid cancer: a retrospective study of 54 patients in a single center

“…And a near-TT or TT can greatly reduce the risk of recurrence and subsequent second surgery. 10 , 11 TT can also optimize or reduce the utilization of postoperative 131 I treatment, and benefits serum Tg as tumor marker to detect recurrent or persistent lesions. In the present study, the bilateral and multifocal lesions were 25.93% and 31.48%, respectively, which was lower than that quoted in ATA children guidelines.…”

Surgical Treatment of Pediatric and Adolescent Papillary Thyroid Cancer: a Retrospective Study of 54 Patients in a Single Center

“…The 2015 ATA pediatric guidelines recommended TT for the majority of children with PTC. The rationale for this recommendation is based on multiple studies showed an increased incidence of bilateral and multifocal lesions (30% and 65%, respectively) [16,17], while a near-TT or TT can greatly reduce the risk of recurrence and subsequent second surgery [18][19][20]. TT can also optimize or reduce the utilization of postoperative 131 I treatment, and bene ts serum Tg as tumor marker to detect recurrent or persistent lesions.…”

“…According to ATA adult guidelines [8], NCCN guidelines(Version 2.2020)and ATA pediatric guidelines [11], Although TT is recommended for the majority of children with PTC, the extent of thyroidectomy is still controversial. The main problem is the in uence of surgical resection scope on tumor recurrence and potential complications (such as transient/permanent postoperative hypoparathyroidism and recurrent laryngeal nerve injury) [19,20,23,24]. Wang et al [25] reported that TT can not reduce recurrence, but only increase the surgical complications.…”