Thyroid Surgery in Children: A 5-Year Retrospective Study at a Single Paediatric Surgical Center and Systematic Review

Abstract

The aim of this study was to analyse and evaluate our 5-year experience in paediatric thyroid surgery, as well as the specificities of this kind of surgery in the literature. This retrospective study was based on 19 operations in 17 patients aged from 5 to 17 years who were operated on due to thyroid pathology from 2017 until 2022. We presented data on surgical procedures and complications following surgery. Most of the patients were adolescent girls. The most common clinical presentations included enlarged thyroid gland, followed by thyroid nodules and hyperthyroidism. Eight total thyroidectomies, five left lobectomies, five right lobectomies, and three central neck dissections were performed. The most common histopathological diagnosis was hyperplastic diffuse colloid goitre, followed by papillary carcinoma, cystic nodule, follicular adenoma, Hashimoto thyroiditis and toxic adenoma. Postoperative course was uneventful, with four mild complications (one wound infection, one manifest hypocalcaemia, and two transitory recurrent laryngeal nerve paralysis). In our literature review, eighteen full-text articles were included and analysed. This study demonstrated that thyroid surgery in paediatric population is a safe and efficient procedure. Thyroid pathology in children significantly differs from that in the adults, and paediatric surgeons should be included into the team managing such cases.

Thyroidectomy in children and adolescents: a systematic review

“…In a large series of 175 patients, Scholz et al reported thyroid nodules as the leading indication for thyroidectomy (83%), followed by hyperthyroidism (7%) and goiter (7%); cancer was found in 36%, and thus papillary TC in 85% ( 38 ). In Bukarica et al retrospective observational study, the prevalence of TC increased in adolescence ( 14 ). Al-Qurayshi et al studied 361 patients operated over a period of 5 years in multiple centers; thyroid diseases included 19% TC, 5.4% MEN-2, 33.6% toxic nodular disease, and 42% non-toxic benign disease ( 17 ).…”

“…Thyroidectomy is more frequent in female patients (up to 80%) and approximately in individuals aged 14 years old ( 14 , 17 , 19 , 21 , 24 , 25 ).…”

“…Therefore, they suggested that referring patients for surgery earlier could prevent complications in benign thyroid disease ( 34 ). Bukarica et al reported two transient RLN paralyses in their series of 19 operations, which were successfully treated with neurotropic medicines, glucocorticoids and vasodilators ( 14 ). In Scholz et al series permanent unilateral vocal cord paralysis was documented in 2 children after resection for malignancy ( 38 ).…”

A critical update on the management of retrosternal goiter

“…To overcome these limitations, the use of the Clavien-Dindo system may be a solution: proposed in 1992 and revised in 2004, it appears reliable as a compelling tool for quality assessment in surgery worldwide. This classification system was reported as simple, reproducible, logical, useful, and comprehensive 96 and it is beginning to be implemented also in thyroid surgery 97 .…”