Thyroid surgery in children and adolescents: results from a multi-institutional German and Austrian database
Theresia Weber1, Rainer Hummel1, Christian Vorländer2
1Klinik für Endokrine Chirurgie, Marienhaus Klinikum Mainz, Germany.
Insights
This study analyzed recent pediatric thyroid surgery outcomes in Germany and Austria, finding common benign conditions and advanced thyroid cancers. While survival is excellent, longer follow-up is needed for pediatric thyroid cancer patients.
Area of Science:
- Endocrinology
- Pediatric Surgery
- Oncology
Background:
- Paediatric thyroid surgery outcomes are sparsely documented.
- Limited data exists on recent trends and complications.
- Multicentre studies are crucial for comprehensive analysis.
Purpose of the Study:
- To report recent outcomes of paediatric thyroid surgery.
- To analyze pathologies and complications in young patients.
- To establish a baseline for future research and clinical practice.
Main Methods:
- Prospective data collection from the StuDoQ|Thyroid registry (March 2017 - August 2022).
- Inclusion of patients aged 18 years or younger undergoing thyroid surgery.
- Analysis of benign and malignant pathologies, surgical complications, and patient demographics.
Main Results:
- 604 patients (mean age 15.4 years, 75% female) from 90 institutions.
- Common benign conditions: nodular goitre, follicular adenoma, Graves' disease.
- Thyroid malignancies included papillary (77.8%), follicular (10.3%), and medullary (8.7%) thyroid carcinoma, often advanced with lymph node metastases (45.9% in PTC).
- Recurrent laryngeal nerve injury occurred in 4.9% (early) and 0.7% (persistent).
- Postoperative hypoparathyroidism correlated with specific pathologies and lymph node dissection.
Conclusions:
- Pediatric papillary and follicular thyroid carcinomas frequently present at advanced stages.
- Papillary thyroid carcinoma showed persistent or recurrent lymph node metastases.
- Excellent overall survival was observed, yet extended follow-up is essential.
Background:
Outcomes of paediatric thyroid surgery have only been reported in smaller series or over long intervals. The aim of this multicentre study was to describe the recent outcomes of paediatric thyroid surgery in Germany and Austria.
Methods:
Patients aged less than or equal to 18 years who underwent thyroid surgery and were prospectively documented in the StuDoQ|Thyroid registry between March 2017 and August 2022 were studied.
Results:
In total, 604 patients from 90 institutions were included. The mean age was 15.4 years and 75 per cent of patients were female. The most frequent benign pathologies were nodular goitre (35.6 per cent), follicular adenoma (30.1 per cent), and Graves' disease (28.5 per cent). Among 126 thyroid malignancies, papillary thyroid carcinoma was diagnosed in 77.8 per cent of patients, follicular thyroid carcinoma was diagnosed in 10.3 per cent of patients, and medullary thyroid carcinoma was diagnosed in 8.7 per cent of patients. Lymph node metastases were found in 45.9 per cent of patients with papillary thyroid carcinoma and in 36.4 per cent of patients with medullary thyroid carcinoma. Vascular invasion was found in 62.9 per cent of patients with follicular thyroid carcinoma. The mean tumour diameters were 18, 42, and 13 mm in patients with papillary thyroid carcinoma, follicular thyroid carcinoma, and medullary thyroid carcinoma respectively. Early postoperative recurrent laryngeal nerve injury was seen in 27 of 556 patients (4.9 per cent) (22 of 617 (3.6 per cent) nerves at risk with intermittent intraoperative nerve monitoring and 5 of 237 (2.1 per cent) nerves at risk with continuous intraoperative nerve monitoring). Persistent recurrent laryngeal nerve injury was documented in 4 of 556 patients (0.7 per cent). Early postoperative hypoparathyroidism correlated with Graves' disease, thyroid carcinoma, and lymph node dissection.
Conclusion:
Papillary thyroid carcinoma and follicular thyroid carcinoma in children were often advanced at presentation. Persistent or recurrent lymph node metastases were mainly seen in papillary thyroid carcinoma. Overall survival was excellent, but longer follow-up is needed.
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