Paediatric thyroidectomy: When and why? A 25-year institutional experience
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Read the article on jpedsurg.org ↗Article · Mar 2022 · 1 min read
In brief
In brief
Retrospective 25-year study of 87 pediatric thyroidectomy cases identifies Graves disease and malignancy as primary indications, with 43.9% cancer risk in nodular presentations. Intraoperative nerve monitoring reduced vocal cord palsy; hypocalcemia was common but usually transient. Long-term disease-free survival achieved in thyroid cancer patients.
Written by the GCMD Library team from the article.
Objective
Thyroidectomy in paediatric patients is relatively uncommon. In this study, we reviewed our experience of thyroidectomy in children and identified risk factors associated with postoperative complications.
Methods
We performed a retrospective analysis of pediatric patients who had thyroidectomy in our institution between April 1995 and January 2021. Demographic data, preoperative cytological findings, indications of surgery, surgical complications and histological results were analysed.
Results
A total of 87 paediatric patients with 92 thyroidectomy were identified. The indications for surgery were Graves' disease refractory to medical treatments (40.2%), benign thyroid nodules or multinodular goitre (26.4%), thyroid carcinoma (23.0%) and multiple endocrine neoplasm type 2A syndrome (10.3%). Patients presented with thyroid nodules or cervical lymph nodes had a 43.9% risk of malignancy.
66 total thyroidectomy were done with median operation time of 134 minutes(102-170), while 26 hemi-thyroidectomy were performed (Right side 12/92, Left side 14/92) with median operation time of 65 minutes(49-102). The median postoperative hospital stay was 2 days(1-4). Intraoperative neck dissection (p=0.003), drain insertion (p=0.001) and hypocalcaemia requiring medical treatment (p=0.004) were associated with longer hospital stay.
The median follow-up was 11.3 years (3.0-16.8). 32% patients had immediate postoperative hypocalcaemia and 8% patients had permanent hypoparathyroidism. Transient vocal cord palsy was found in 3 patients(3%) and all resolved within 5-month time upon reassessment direct laryngoscopy. The use of intraoperative recurrent laryngeal nerve monitoring was associated with less vocal cord palsy (p=0.022).
The median disease-free survival was 13.7 years(7.4-17.7) for patients operated for well-differentiated thyroid carcinoma(WDTC). Among the 9 patients who had prophylactic total thyroidectomy for MEN2A syndrome, 44% were found to have medullary thyroid microcarcinomas on pathology.
Conclusions
Surgical management of paediatric thyroid disease can be complex. Postoperative hypocalcaemia and vocal cord palsy were usually transient after total thyroidectomy. The use of intraoperative recurrent laryngeal nerve monitoring had resulted in less vocal cord palsy. Long-term disease-free survival of patients with thyroid cancer had been achieved with multi-disciplinary management in our centre.
Level of Evidence: Retrospective Comparative Study; Level III