Nodular recurrence and hypothyroidism following partial thyroidectomy for benign nodular thyroid disease in children and adolescents

Akkari, M.; Schmitt, David D.; Jeandel, C.; Raingeard, I.; Blanchet, C.; Cartier, C.; Garrel, R.; Guerrier, B.; Makeïeff, M.; Mondain, M.

doi:10.1016/j.ijporl.2014.07.037

Cited by 8 publications

(17 citation statements)

References 37 publications

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“…When reviewed by an experienced cytopathologist, needle aspiration cytologic analysis categorized according to the Bethesda Thyroid Cytopathology Reporting System can diagnose or rule out thyroid cancer with high accuracy . Thus, we strongly recommend aspiration before any consideration of diagnostic lobectomy, which carries the obligate risk of surgical complications and up to a 20% risk of postoperative hypothyroidism . Repeated aspiration should be offered if initial cytologic findings are inadequate, as repeated biopsies are usually diagnostic …”

Section: Discussionmentioning

confidence: 99%

“…[19][20][21] Thus, we strongly recommend aspiration before any consideration of diagnostic lobectomy, which carries the obligate risk of surgical complications 30 and up to a 20% risk of postoperative hypothyroidism. 31 Repeated aspiration should be offered if initial cytologic findings are inadequate, as repeated biopsies are usually diagnostic. 19,32 The cytologic appearance of an ectopic intrathyroidal thymus shows benign-appearing lymphocytes, usually with a minimal or no epithelial cell component.…”

Section: Discussionmentioning

confidence: 99%

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Ectopic Intrathyroidal Thymic Tissue Mimicking Thyroid Nodules in Children

Frates

Benson

Dorfman

et al. 2017

J of Ultrasound Medicine

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Ectopic intrathyroidal thymic tissue is a benign lesion of nonthyroid origin occasionally found in the pediatric thyroid gland. Accurate diagnosis of such lesions is critical to avoid unnecessary biopsy or surgery. Twelve children referred to our center for the concern of thyroid nodules were found to have intrathyroidal thymic tissue. Most of the lesions had a classic sonographic appearance of a hypoechoic mass with sharp margins and multiple focal internal nonshadowing echogenicities identical to thymic tissue. Sonography and, in select cases, fine-needle aspiration can be used to diagnose benign thymic tissue within the thyroid and avoid unnecessary surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ectopic Intrathyroidal Thymic Tissue Mimicking Thyroid Nodules in Children

Frates

Benson

Dorfman

et al. 2017

J of Ultrasound Medicine

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“…Biological hypothyroidism occurred on average 5.6 months after surgery [41]. On monitoring thyroid function, patients with hypothyroidism received levothyroxine substitution following the operation.…”

Section: Discussionmentioning

confidence: 99%

“…Moalem et al [10] assessed that approximately 50% of studies on the subject support this hypothesis, but with sometimes questionable methodology. Some studies indicated that substitutive levothyroxine therapy does not have any influence on nodular recurrence [41,43,44]. …”

Section: Discussionmentioning

confidence: 99%

Total Thyroidectomy versus Bilateral Subtotal Thyroidectomy for Bilateral Multinodular Nontoxic Goiter: A Meta-Analysis

Li²,

Zhou³

2016

ORL

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Aim: The aim of this meta-analysis is to assess and validate the feasibility and safety of total thyroidectomy (TT) when compared to bilateral subtotal thyroidectomy (BST) for bilateral multinodular nontoxic goiter (BMNG). Materials and Methods: PubMed, Web of Knowledge, and Ovid's database were searched for studies published in English language between January 1990 and December 2014. A meta-analysis was performed to compare the complications and recurrences of TT versus BST. The search terms used were ‘total thyroidectomy', ‘bilateral subtotal thyroidectomy', ‘multinodular nontoxic goiter' and ‘randomized clinical trial'. The reference lists of relevant studies were checked manually to locate any missing studies. Results: Four trials with a total of 1,078 patients were analyzed. Although the incidence of transient hypoparathyroidism was higher in TT than in BST (OR = 2.59, 95% CI [1.58-4.24], p = 0.0002), TT was associated with a significantly lower incidence of recurrence (OR = 0.04, 95% CI [0.01, 0.17], p < 0.0001). There were no statistically significant differences for the presence of transient/permanent recurrent laryngeal nerve palsy and permanent hypoparathyroidism between the two groups. Conclusion: TT is a feasible and safe procedure for patients with BMNG. Although TT involves a significantly higher risk of postoperative transient hypoparathyroidism, it has a lower recurrence rate than BST.

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“…Thyroid dysfunction following hemithyroidectomy can negatively affect growth and brain maturation in infancy and childhood, and the clinical outcome varies with age and the severity of thyroid impairment. The effects of thyroid hormones on growth, skeletal maturation and cognitive development in adolescent should be considered (18). The beneficial effects of L-T4 on the clinical symptoms and signs of hypothyroidism and goiter, especially in adolescent with Hashimoto's thyroiditis, have been confirmed in many studies (19–21).…”

Section: Discussionmentioning

confidence: 99%

Management of Subclinical and Overt Hypothyroidism Following Hemithyroidectomy in Children and Adolescents: A Pilot Study

Chen

Hou

et al. 2019

Front. Pediatr.

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Background: To reduce surgical complications and avoid lifelong thyroid hormone replacement, hemithyroidectomy is preferred in children and adolescents with benign nodular thyroid disease. However, hypothyroidism following hemithyroidectomy may occur, and postoperative thyroid hormone replacement for hypothyroidism following hemithyroidectomy is usually administered without a full understanding of the clinical characteristics of hypothyroidism.Methods: To investigate the incidence and risk factors of hypothyroidism after hemithyroidectomy in children and adolescents, and to identify whether postoperative thyroid hormone replacement is necessary, a retrospective review of 43 patients under 18 years of age who underwent hemithyroidectomy from January 2009 to October 2016 was conducted. All hypothyroid patients were retrospectively analyzed to determine the incidence and predisposing factor(s) of postoperative hypothyroidism. All patients were measured regarding age, sex, serum thyrotropin (TSH), anti-thyroid antibody, and histological evidence of lymphocytic infiltration. Hypothyroid patients were measured for symptoms, timing of diagnosis, and thyroid hormone replacement.Results: The mean age at the time of surgery was 13.65 ± 3.04 years. Of the cohort, 34 patients were female (79.07%), and the mean follow-up time was 28 ± 9 months. Hypothyroidism was diagnosed in 11 of the 43 patients. The mean postoperative TSH level was 7.17 ± 2.13 μIU/ml. The mean preoperative TSH level was 3.11 ± 0.59 μIU/ml in hypothyroid patients compared with 1.92 ± 0.72 μIU/ml in euthyroid patients (P < 0.05). A preoperative TSH level >2.2 μIU/l and lymphocytic infiltration graded 3 or 4 were found to be independent risk factors for the development of hypothyroidism. There were no significant differences between groups in terms of patient age or sex.Conclusions: In the pediatric and adolescent population, patients with elevated preoperative TSH levels or the presence of lymphocytic infiltration may increase the risk of risk of hypothyroidism. In our study, postoperative levothyroxine (L-T4) treatment was necessary in 16.28% of cases after hemithyroidectomy. Patients with mild postoperative hypothyroidism should be followed up, without the need for immediate L-T4 replacement, so as to expect patients to recover spontaneously.

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Nodular recurrence and hypothyroidism following partial thyroidectomy for benign nodular thyroid disease in children and adolescents

Cited by 8 publications

References 37 publications

Ectopic Intrathyroidal Thymic Tissue Mimicking Thyroid Nodules in Children

Ectopic Intrathyroidal Thymic Tissue Mimicking Thyroid Nodules in Children

Total Thyroidectomy versus Bilateral Subtotal Thyroidectomy for Bilateral Multinodular Nontoxic Goiter: A Meta-Analysis

Management of Subclinical and Overt Hypothyroidism Following Hemithyroidectomy in Children and Adolescents: A Pilot Study

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