Background: Improved tools for diagnosis, a higher malignancy risk in thyroid nodules and the referral to surgery in Graves disease when medication fails, have lead to increased thyroidectomies in children.
Objective and hypotheses: The aim of our study was to evaluate thyroid surgery outcomes and the presence of transient or permanent complications, in a cohort of children who underwent surgery, with the same surgical team, in the last 10 years.
Method: children (24 F/11 M) were selected for thyroid surgery and longitudinally followed-up for 24.3±13.88 (mean ± sds) months. Clinical features and indications to surgery were evaluated, along with complications: transient or permanent hypoparathyroidism, transient or permanent RLN (Recurrent Laryngeal Nerve) injury and post-operative bleeding.
Results: 20 (15 F/5M) children underwent thyroid surgery for benign conditions (mean age 13.88±2.33 years), and 15 (9 F/6 M) for malignant ones (mean age 13.93±3.59 years), with no significant age difference in the two groups (P value 0.96). Of the benign conditions, 6 were Graves disease and 14 other conditions; of the malignant ones, 1 was a multiple endocrine neoplasia type 2, 13 were papillary and 1 was medullary carcinoma. 12 children with malignant conditions underwent total thyroidectomy (TT): 3 of which with central compartment lymphadenectomy and 4 with central and lateral-cervical lymphadenectomy; 3 had an initial hemi-thyroidectomy, followed by complete removal of thyroid gland. Of the benign conditions, 13 underwent thyroidectomy while 7 underwent hemi-thyroidectomies. 5 children (all malignant conditions) suffered from post-operative hypoparathyroidism (only 1 was transient). One presented transient RLN injury (TT from benign condition) and 1 post-operative bleeding (TT for malignant condition).
Conclusion: Using a multidisciplinary team (endocrinologists, radiologists and surgeons), a Minimally Invasive Video-Assisted Thyroid Surgery (MIVAT) approach for thyroid surgery and a careful pre-surgical preparation (Graves disease) allowed us to reduce permanent severe complications in children.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology