Evolution of pediatric thyroid surgery at a tertiary medical center

Abstract

Background Thyroidectomy in the pediatric population is often avoided due to perceived risks in children. With growing subspecialization and establishment of high volume endocrine surgery centers, the indications for thyroid surgery and extent of resection continue to change. We examined the evolution of pediatric thyroid surgery at a high volume tertiary medical center. Methods From our prospectively collected database, we reviewed medical records of individuals younger than 19 years who underwent thyroidectomy at our institution from 1994 to 2009. Patients were divided into two groups: 1) before establishment of our endocrine surgery center (1994–2001) and 2) since establishment of the center (2002–2009). Results We identified 78 operations performed on 74 patients with a median age of 15 (range 3–18) years. We found that the number of patients doubled in the later time period, with 26 operations in Group 1 and 52 in Group 2. The age of patients and percentage of females were similar between groups. After establishment of the endocrine surgery center, there was a significant increase in total thyroidectomies for all indications, including significantly more for benign disease. Overall, 9% of the patient population experienced transient complications, with no permanent complications or long-term sequelae. Conclusions Pediatric thyroid surgery is extremely safe, especially when performed at a high volume endocrine surgery center. We more often select surgical treatment for benign disease and choose total thyroidectomy over limited resection. This may reflect increasing confidence in the safety and efficacy of surgery and reliability of thyroid hormone replacement.

Patologia quirúrgica de la glándula tiroides en pacientes pediátricos

“…Al igual que lo reporta la literatura, la patología de la glándula tiroides es más frecuente en pacientes del sexo femenino frente al sexo masculino a razón de 4:1 (1)(2)(3)6,7) . Según nuestros hallazgos, en la distribución por edades, el 56,6% del total de los casos se encontraron entre 13 a 16 años.…”

“…Los nódulos tiroideos suelen ser infrecuentes en la edad pediátrica, presentándose en entre 1,6-1,8% de niños y adolescentes; sin embargo, el riesgo de malignidad es alto en comparación a los casos presentados en adultos (26,4% frente a un 5%, respectivamente) (1,2,3) . Esto puede deberse a que los folículos tiroideos son metabólicamente más activos en menores de 12 años, lo cual facilitaría la diseminación en edades prepuberales (4,5) .…”

“…El tumor es la característica más frecuente tanto para patologías benignas como para malignas, además de presentarse como quistes, nódulos únicos, bocio difuso o multinodular. Segun otros reportes, la patología benigna tumoral corresponde al 71,9% de los casos, con diagnósticos desde adenomas o nódulos hiperfuncionantes, enfermedad de Graves resistente al tratamiento, hasta tiroiditis (3,4,8) . La patología maligna puede presentar el 25-42% de los casos de tumores tiroideos, y suelen aparecer con síntomas generales como disfonía, disfagia o disnea; y en el 40-80% se manifiestan síntomas regionales como la presencia de ganglios cervicales.…”

Pediatric Thyroid Disease: When is Surgery Necessary, and Who Should be Operating on Our Children?

“…These reports highlight the benefits of increased volume at both the surgeon and institutional level (50,51). High-volume centers are more likely to have systematic approaches to the pre-operative workup and post-operative care of these patients, as well as early involvement of dedicated pediatric and endocrine specialists.…”

Thyroid Adenomas in Children

“…Немалую опасность представляет вариабельность анатомии расположения возвратного гортанного нерва. Возвратный гортанный нерв без возвратного хода встречается в 0,5-2,2% случаев, причем гораздо реже слева (всего 0,04%) [52,55]. Введение в практику хирурга-эндокринолога аппаратного нейромониторинга существенно облегчает визуализацию нерва [56].…”