Thyroid surgery in children: a single pediatric center experience

The increasing incidence of thyroid disease in children requires appropriate training for pediatric surgeons. The specific characteristics of this age group require a different treatment approach from that used in adults. The authors report their pediatric experience over a 5-year period. For each patient, we analyzed the indication for surgery, type of procedure, postoperative complications, and follow-up, with a mean follow-up of one year. The mean age of the 25 patients treated was 12 years (range, 5–16 years), and the male-to-female ratio was 1:1.27. The most common clinical presentation was asymptomatic neck swelling or an incidental finding of a thyroid nodule, often detected during evaluation for weight loss or follow-up for another condition. All patients with thyroid nodules underwent preoperative fine-needle aspiration, and surgery was indicated in cases of malignancy. Four patients were diagnosed with Graves’ disease. Surgical treatment was performed by a pediatric surgeon and a general surgeon. All patients underwent total thyroidectomy, and three underwent lymph node dissection. The mean operative time was 80.7 min (range, 61.0–100.4 min). Histopathological examination of the surgical specimens showed 22 cases of carcinoma (18 papillary and 4 follicular) and 3 cases of autoimmune thyroid disease. The mean hospital stay was 4 days (range, 3–6 days). Transient asymptomatic hypocalcemia was observed in seven patients (28%). Preoperative laryngoscopy identified unilateral vocal cord paralysis in two patients (8%); these abnormalities were present before surgery and were therefore not considered surgical complications. Postoperative radioiodine treatment was administered to three patients. Pediatric endocrinologists conducted postoperative followup, including clinical assessment, ultrasound, and laboratory tests. Thyroidectomy in children should be performed in a specialized multidisciplinary pediatric center, with the involvement of an experienced thyroid surgeon when appropriate.