Thyroid surgery in children: a single pediatric center experience

The increasing incidence of thyroid disease in children requires appropriate training for pediatric surgeons. The specific characteristics of this age group require a different treatment approach from that used in adults.The authors report their pediatric experience over a 5-year period. For each patient, we analyzed the indication for surgery, type of procedure, postoperative complications, and follow-up, with a mean follow-up of one year. The mean age of the 25 patients treated was 12 years (range, 5-16 years), and the male-to-female ratio was 1:1.27. The most common clinical presentation was asymptomatic neck swelling or an incidental finding of a thyroid nodule, often detected during evaluation for weight loss or follow-up for another condition. All patients with thyroid nodules underwent preoperative fine-needle aspiration, and surgery was indicated in cases of malignancy. Four patients were diagnosed with Graves' disease. Surgical treatment was performed by a pediatric surgeon and a general surgeon. All patients underwent total thyroidectomy, and three underwent lymph node dissection. The mean operative time was 80.7 min (range, 61.0-100.4 min). Histopathological examination of the surgical specimens showed 22 cases of carcinoma (18 papillary and 4 follicular) and 3 cases of autoimmune thyroid disease. The mean hospital stay was 4 days (range, 3-6 days). Transient asymptomatic hypocalcemia was observed in seven patients (28%). Preoperative laryngoscopy identified unilateral vocal cord paralysis in two patients (8%); these abnormalities were present before surgery and were therefore not considered surgical complications. Postoperative radioiodine treatment was administered to three patients. Pediatric endocrinologists conducted postoperative follow-up, including clinical assessment, ultrasound, and laboratory tests. Thyroidectomy in children should be performed in a specialized multidisciplinary pediatric center, with the involvement of an experienced thyroid surgeon when appropriate.