Thyroid surgery in children and young adults: potential overtreatment and complications

Abstract

Purpose Thyroid nodules in the pediatric population are more frequently associated with malignant thyroid disease than in adult cohorts. Yet, there is a potential risk of surgical overtreatment. With this single center study, an analysis of potential overtreatment for suspected malignant thyroid disease in children and young adults was aimed for. Methods In a period from 2005 to 2018, 155 thyroid operations in children and young adults performed at the University Medical Center Mainz, Germany, were analyzed (patient age 3-20 years, 117 female). Cases were categorized for preoperative diagnosis: non-malignant (group I, n = 45) and malignant thyroid disease (group II, n = 110). Postoperative parameters (histology, complication rates) were assessed and compared between groups. Results 91.1% of group I were histologically benign. 44.5% of group II harbored malignancy. Permanent hypoparathyroidism was documented in group I (2.7%) and in group II (1.4%, p = 1.000). Wound infections were absent in group I but observed in group II (0.9%, p = 1.000). Transient vocal cord palsy was recorded only in group I (2.3%, 2/85 vs. 0/177 nerves at risk, p = 0.104). Permanent vocal cord palsies were absent. Conclusion Preoperative diagnoses were correct in over 90% of group I and in nearly 45% of group II. The high proportion of carcinomas in group II ruled out the issue of potential overtreatment. The risk of severe postoperative complications was equally low in both patient groups.

Outcome and complications after surgery for thyroid carcinoma in pediatric age—an evaluation of practice

“…Additionally, a recent systematic review in 2021 declared that the mean percentage from 15 studies was about 35.5% [ 30 ]. Permanent hypocalcemia did not happen in any patient within our study as well as another report [ 4 ], and it was only encountered in 1% and 3% of patients in previous studies [ 32 , 33 ]. Eventually, the majority of surgical complications in our study as well as the aforementioned studies [ 4 , 18 , 24 , 32 , 33 ] were short-term, transient morbidities that were cured after conservative treatment and without any further sequelae.…”

“…Permanent hypocalcemia did not happen in any patient within our study as well as another report [ 4 ], and it was only encountered in 1% and 3% of patients in previous studies [ 32 , 33 ]. Eventually, the majority of surgical complications in our study as well as the aforementioned studies [ 4 , 18 , 24 , 32 , 33 ] were short-term, transient morbidities that were cured after conservative treatment and without any further sequelae. Consequently, we believe that surgical resection for such tumors can be safe especially when performed by a specialized, dedicated team.…”

“…In this study, transient hypocalcemia was encountered in 9% of patients. Other investigators, however, reported this temporary complication in 21%, 27.3%, and 41% of their patients [4,32,33]. Additionally, a recent systematic review in 2021 declared that the mean percentage from 15 studies was about 35.5% [30].…”

2022 European Thyroid Association Guidelines for the management of pediatric thyroid nodules and differentiated thyroid carcinoma

“…In the discussion of whether subtotal thyroid resection or lobectomy should be considered instead of total thyroidectomy in the treatment of pediatric DTC, the associated complication risks (i.e., hypoparathyroidism and recurrent laryngeal nerve palsy) need to be weighed against the likelihood of persistent and recurrent DTC [82,83]. Total thyroidectomy is required to enable radioiodine therapy [79,82,83]. Adequate primary surgery is the premise to avoid neck recurrence and defines the ongoing course of the disease [79,82,83].…”

“…hypoparathyroidism and recurrent laryngeal nerve palsy) need to be weighed against the likelihood of persistent and recurrent DTC ( 81 , 82 ). Total thyroidectomy is required to enable radioiodine therapy ( 78 , 81 , 82 ). Adequate primary surgery is the premise to avoid neck recurrence and defines the ongoing course of the disease ( 78 , 81 , 82 ).…”