Pediatric thyroid surgery and management of thyroid nodules - an institutional experience over a 10-year period

We reviewed our institutional experience in the diagnosis and management of pediatric thyroid nodules and well-differentiated thyroid carcinoma (WDTC), highlighting the unique challenges in this population.

IRB approved retrospective chart review was conducted on patients who underwent fine needle aspiration (FNA) or thyroid surgery from 1/1/2001 to 12/31/2010 at Rady Children's Hospital San Diego, a tertiary referral center in Southern California. Patients thus identified who completed their initial treatment at our institution were included.

Total of 79 subjects qualified; 20 had FNA only, and 59 underwent thyroid surgery. Of the latter, 29 had benign histology and 30 had WDTC. Average age was 14.5 years with a female: male ratio of 4:1 for WDTC versus 1.6:1 for benign nodules. When compared to final pathology, malignancy rate was high in indeterminate FNA cytology at 60 %. Neck metastasis was noted in 40 % and pulmonary spread in 10 % of patients. There was a 2.75 fold increase in malignant cases (n = 22) treated during 2006-2010 compared to 2001-2005 (n = 8) with more advanced disease at initial presentation. Ninety percent of WDTC patients received adjuvant I-131 treatment with an initial average dose of 132.4 mCi. Despite aggressive initial presentation, 26/30 patients had no evidence of disease at last follow-up, with an average length of 40.3 months.

In recent years, we are managing significantly more WDTC cases at our institution with advanced disease at the onset. Malignancy rate on indeterminate cytology is higher than reported in adults with an overall high rate of malignancy in thyroid nodules removed in this cohort. Disease control and short-term outcome is still excellent. The recently published pediatric guidelines for WDTC will further standardize management.