Related Experiment Videos
[Surgical treatment of thyroid diseases in children]
M Giroux1, D Saint-Vil, J G Desjardins
1Service de Chirurgie Générale Pédiatrique, Hôpital Sainte-Justine, Montréal, Québec, Canada.
Insights
Pediatric thyroid nodules require prompt evaluation due to a high risk of malignancy. Aggressive surgical management and radioactive iodine therapy for recurrent or metastatic disease ensure an excellent prognosis.
Area of Science:
- Pediatric endocrinology
- Surgical oncology
- Thyroid disease management
Context:
- Retrospective review of 50 pediatric patients undergoing thyroid surgery between 1980-1995.
- Evaluated clinical presentations, diagnostic methods, surgical procedures, and outcomes.
Purpose:
- To review institutional experience with pediatric thyroid surgery.
- To identify prognostic factors influencing outcomes in pediatric thyroid cancer.
Summary:
- Thyroid nodules in children necessitate rapid investigation, with a significant proportion revealing cancerous lesions.
- Surgical interventions ranged from lobectomy to total thyroidectomy, with 9 patients requiring completion thyroidectomy for carcinoma.
- Pathology revealed well-differentiated carcinoma (52%), medullary carcinoma (20%), and benign lesions (28%). Metastases were present in 9 patients at initial surgery.
Impact:
- Highlights the high prevalence of malignancy in pediatric thyroid nodules.
- Demonstrates the effectiveness of aggressive surgical treatment and post-operative radioactive iodine (I131) in managing recurrent or metastatic thyroid cancer.
- Confirms a 100% survival rate with appropriate management, underscoring the importance of timely diagnosis and treatment.
Unlabelled:
In order to review the experience of a single institution with thyroid surgery and identify prognostic factors, we did a retrospective chart review of all patients who underwent thyroid surgery between 1980 and 1995. Fifty patients, 32 girls and 18 boys, underwent thyroid surgery. Clinical presentation include a thyroid nodule (36 patients), a family history of MEN syndrome with a positive pentagastrin stimulation test (10), diffuse nodular goitre (3) and a neonatal cervical mass (1). Radiologic investigation include ultrasonography in 58% of cases, radionucleide imaging in 70% of cases. The mean age at surgery was 13.3 years and the delay between onset of symptoms and diagnostic was 13 months. Twenty-one patients had a lobectomy +/- isthmectomy, 19 had a total thyroidectomy and 10 had a subtotal thyroidectomy. Nine patients required a second surgery to complete the surgical treatment, and perform a total or near total thyroidectomy when the final pathology showed a carcinoma. A well differentiated carcinoma was found in 52% of the patients, a medullary carcinoma in 20% and a benign lesion in 28% of cases. Nine patients had local or distant metastases at initial surgery. Post-op treatment consisted of suppressive hormonotherapy in all cases of cancer and radioactive iodine when recurrence occurred in 24% of patients and when metastasis where present. Survival remained at 100%.
Conclusion:
Thyroid nodules should be rapidly investigated in children because of a high potential of cancerous lesions. With an aggressive surgical treatment and post-op I131 for recurrent lesions and metastasis the prognostic remains excellent.