Thyroid gland diseases and tumours. Surgical aspects

In contrast to the pediatric endocrinologist, the pediatric surgeon is seldom confronted with thyroid gland diseases. According to the literature, the indications for and the scope of thyroid gland surgery are extremely varied. The absolute indications for surgical treatment are primarily teratomas and carcinomas; relative indications include adenomas and cysts, ectopia, hyperthyroidism, thyroiditis and goiter in the newborn. This chapter is concerned with teratomas, carcinomas, ectopy of the thyroid gland and hyperthyroidism. The rare genuine midline teratoma supplanting the thyroid gland and the lateral teratoma in the neck containing thyroid tissue must be operated on immediately for diagnostic reasons. Thyroid carcinoma in childhood is differentiated in over 90% of cases, with a 10-year cure rate of 80-90%. Undifferentiated and medullary carcinomas are rare. Extensive surgery in the form of total thyroidectomy and radical neck dissection is usually unnecessary. When lung metastases are present in medullary carcinoma, total thyroidectomy is imperative. The advantages and disadvantages of total or subtotal thyroidectomy in hyperthyroidism are discussed. Subhyoid and basioglossal ectopias should not be removed surgically because these cosmetically disturbing or symptomatic tumours can be conservatively resected by means of hormone substitution therapy today.