The Canadian Pediatric Thyroid Nodule Study: an evaluation of current management practices

Thyroid nodules in children often require surgical treatment. We evaluated management practices for these across Canada.

Patient records from 9 Canadian pediatric centers of children undergoing surgery for thyroid nodules over a 6-year period were reviewed. Demographics, presenting features, investigations, surgical treatment, pathology, and complications were assessed.

One hundred and forty-one patients were reviewed (75% female), of whom 117 presented with a palpable mass. Ultrasound and/or thyroid scintigraphy was the most commonly used preoperative imaging studies. Fine-needle aspiration cytology correlated with final pathology in 49% of cases. Overall, the rate of malignancy in this series was 43%, with half being papillary carcinoma. Thirty-two of 57 patients undergoing primary total thyroidectomy had a malignancy; 14 of these had positive preoperative fine-needle aspiration cytologies. Twenty of 71 patients undergoing initial hemithyroidectomy +/- isthmusectomy had a malignancy. Seventeen of these went on to completion thyroidectomy and 3 had malignancy in the second specimen. Hypocalcemia and hoarseness occurred in 14 and 4 patients, respectively. Complications were more common after primary total thyroidectomy; none occurred in patients undergoing completion thyroidectomy.

The incidence of malignancy in pediatric thyroid nodules is high, and the risk of surgical complications significant. With variable management practices across Canada, evidence-based guidelines for diagnosis and surgical treatment may be valuable.