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Updated: Aug 6, 2025
Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
Published on: September 15, 2023
Pediatric thyroid surgery: Retrospective analysis on the first 25 pediatric thyroidectomies performed in a reference
Francesco Quaglino1, Alex Bruno Bellocchia1, Gerdi Tuli2
1General Surgery Division, Maria Vittoria Hospital, Turin, Italy.
Insights
Pediatric thyroid cancer is rare but has higher malignancy rates. Indeterminate nodules (TIR 3B) showed a significantly higher malignancy rate in children, necessitating specialized endocrine surgery centers.
Area of Science:
- Endocrinology
- Pediatric Surgery
- Oncology
Background:
- Pediatric thyroid carcinoma accounts for 4-5% of childhood cancers.
- Thyroid nodules in children present unique challenges compared to adults, including higher malignancy rates and distinct prognostic factors.
Purpose of the Study:
- To evaluate the experience of an adult endocrine surgery unit in managing pediatric thyroid diseases.
- To analyze surgical indications, outcomes, and risk factors in pediatric thyroid surgery.
Main Methods:
- Retrospective analysis of 25 patients (aged 5-17) who underwent thyroid surgery between January 2019 and September 2022.
- Inclusion of data on surgical indications, use of intraoperative nerve monitoring (IONM), fine-needle aspiration (FNA) accuracy, and postoperative outcomes.
Main Results:
- Nodular pathology (73%) was the primary surgical indication, with a 40% overall malignancy rate.
- Indeterminate lesions (TIR 3B) had a 75% malignancy rate, higher than in adults. Prophylactic thyroidectomy in MEN 2A patients confirmed medullary carcinoma.
- Transient hypoparathyroidism occurred in 24% of patients, resolving within 30 days for most.
Conclusions:
- Pediatric thyroid nodules have higher malignancy rates, especially indeterminate lesions.
- Intraoperative nerve monitoring (IONM) is recommended for patients under 12 due to anatomical differences.
- Pediatric thyroid surgery demands specialized centers with experienced endocrine surgeons.
Introduction:
Pediatric thyroid carcinoma represents about 4-5% of all pediatric carcinoma with an incidence of 0.5 cases/100,000, compared to 2-10/100000 cases in the adult population. The aim of this study is to present the experience of a reference adult endocrine surgery unit in charge of the treatment of pediatric thyroid diseases.
Materials And Methods:
From January 2019 to September 2022, 25 patients, aged 5-17, underwent thyroid surgery. We analysed indications for surgery, use of intraoperative nerve monitoring (IONM), definitive histological examination, postoperative outcomes and risk factors related.
Results:
Surgical indication was performed for Graves' disease (27%) and for nodular pathology (73%): of these, four were malignant lesions (TIR4/TIR5), eight with indeterminate characteristics (TIR3A/TIR3B) and four characterized as benign (TIR1/TIR2). Total thyroidectomy (TT) was performed in 76% of cases, three of which were prophylactic for the activation of the RET gene mutation in MEN 2A. IONM was used in eight cases (32%), all patients aged 11 years or less. FNA's accuracy was 100% for lesions typified as benign and malignant (TIR1/TIR2 and TIR4/TIR5). The overall malignancy rate achieved was 40% and in the final histological examination 75% of the TIR 3B lesions were malignant. Six patients (24%) developed hypoparathyroidism in the first postoperative day, with normalization of calcium values within thirty days in 5 patients.
Conclusions:
Pediatric thyroid nodules are rare and distinguished from adult thyroid disease by a worse prognosis and higher malignancy rates. Our work reports a much higher malignancy rate among indeterminate TIR 3B lesions than observed in the adult population and the three patients who underwent prophylactic total thyroidectomy for activating RET gene mutation had all a definitive histological diagnosis of medullary carcinoma. Post-surgical hypoparathyroidism is a common finding in these patients: in most cases the condition is transient and it benefits from supportive therapy. Intraoperative finding of a thinner recurrent laryngeal nerve in younger patients makes nerve isolation more difficult than in adult surgery: IONM is recommended in patients under 12. Pediatric thyroid surgery is challenging, we sustain it requires referral thyroid Centers for thyroid disease with highly skilled general endocrine surgeons.
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