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Updated: Dec 26, 2025
Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
Published on: September 15, 2023
Bilateral papillary thyroid cancer in children: Risk factors and frequency of postoperative diagnosis
Heron Baumgarten1, Carolyn M Jenks2, Amber Isaza3
1Department of Surgery, Pediatric Thyroid Center, Children's Hospital of Philadelphia and Perelman School of Medicine University of Pennsylvania, Philadelphia, PA.
Insights
Nearly 40% of pediatric papillary thyroid cancer (PTC) cases involve bilateral disease, with many occult. Multifocality and lymphadenopathy on ultrasound predict bilateral PTC, supporting total thyroidectomy (TT) for children.
Area of Science:
- Pediatric Oncology
- Surgical Oncology
- Endocrine Surgery
Background:
- Papillary thyroid cancer (PTC) in children often leads to a recommendation for total thyroidectomy (TT) due to the potential for bilateral disease.
- This study evaluates the assumption of bilateral disease incidence in a large pediatric cohort.
Purpose of the Study:
- To assess the prevalence and characteristics of bilateral papillary thyroid cancer (PTC) in pediatric patients.
- To identify preoperative and ultrasound findings that predict bilateral PTC.
- To inform surgical decision-making for pediatric PTC.
Main Methods:
- Retrospective chart review of pediatric patients surgically treated for PTC between 2009 and 2018.
- Analysis of preoperative risk factors, ultrasound findings, and pathology results.
- Definition of bilateral disease included pathological PTC in the contralateral lobe, encompassing microscopic disease.
Main Results:
- 38.4% of pediatric PTC patients had bilateral disease, with 23% diagnosed postoperatively.
- Multifocal disease on ultrasound (OR 2.9) and nodule size >2 cm (OR 3.5) were associated with bilateral PTC.
- Bilateral PTC correlated with extrathyroidal extension, lymphovascular invasion, positive lymph nodes, and extranodal extension.
Conclusions:
- Approximately 38% of children with PTC exhibit bilateral disease, and nearly 25% have occult bilateral involvement.
- Predictive features for bilateral PTC include multifocality, widely invasive disease on ultrasound, and lymphadenopathy.
- Total thyroidectomy (TT) remains the appropriate surgical approach for pediatric patients diagnosed with papillary thyroid cancer.
Background:
The recommendation for children with papillary thyroid cancer (PTC) is total thyroidectomy (TT) based on the incidence of bilateral disease. Evaluating this assumption, we reviewed the characteristics of bilateral PTC in a large cohort of children.
Methods:
A retrospective chart review for patients surgically treated for PTC from 2009 to 2018 analyzing preoperative risk factors, ultrasound findings, and pathology results was performed. Bilateral disease was defined as pathologic PTC in the contralateral lobe, including microscopic disease.
Results:
Of the 172 patients included, 38.4% had bilateral disease with 23% diagnosed postoperatively. Multifocal disease on ultrasound was associated with bilateral disease (OR 2.9, 95% CI 1.5-5.9, p = 0.002). Nodule dimension >2 cm was associated with increased risk for postoperative bilateral disease (OR 3.5, 95% CI 1.6-7.4, p = 0.001). Patients with bilateral disease were more likely to have extrathyroidal extension, lymphovascular invasion, positive central lymph nodes, and extranodal extension (p < 0.001 for all). Diffuse-sclerosing variant PTC was also associated with bilateral disease.
Conclusion:
Thirty-eight percent of children were diagnosed with PTC demonstrate bilateral disease. Nearly one in four have occult bilateral disease. The features that predicted bilateral disease were multifocality, widely invasive PTC on ultrasound, and the presence of lymphadenopathy. Thus, TT is the appropriate surgical approach for pediatric patients with PTC.
Type Of Study:
Clinical Research, Retrospective Review.
Level Of Evidence:
Level IV.
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