Surgery for Graves disease in childhood and adolescence

Abstract

Children and adolescents with thyroid disorders are predominantly treated by pediatricians and pediatric endocrinologists. Surgery for thyroid disorders still represents the third frequent operation in adults in Germany, but is seldomly indicated in children. Thus children and adolescents make up for 1.3% of all our patients and of these 89 patients only 21 (23.6%) suffered from Graves disease. Nevertheless surgery for Graves disease in children and adolescence is recommended because medical therapy has proven a high rate of recurrences in children and because radioiodine is only reluctantly applied to children, at least in Germany.

Surgery versus Radioiodine Therapy as Definitive Management for Graves' Disease: The Role of Patient Preference

“…The risk of radioiodine in children is not clear and is generally avoided at our institution for children under the age of 16. Additionally, higher failure rates of antithyroid medication in children often necessitate surgical treatment (10).…”

Thyroidectomy in Pediatric Patients with Graves’ Disease: A Systematic Review of Postoperative Morbidity

“…In the study by Cohen et al [23], surgery was performed by a low-volume surgeon. The remaining 13 studies did not report whether thyroidectomies were performed by a low- or a high-volume surgeon [12, 16-20, 22, 24-26, 28, 30]. In 3 studies, thyroidectomies were performed by a pediatric surgeon [14, 21, 22], in 3 studies by an endocrine surgeon [11, 26, 29], and in 4 by both pediatric and adult surgeons [12, 18, 19, 31].…”

“…Sugino et al [26] reported all patients to be euthyroid at the time of surgery, without reporting the used preoperative treatment protocol. The other included studies did not report on preoperative preparation or preoperative thyroid hormone levels in their patients [10, 13, 15, 17-22, 24, 25, 28-31]. Further characteristics of the included studies are shown in Table 1.…”

“…Four studies reported that one of their patients was diagnosed with permanent RLN injury (Table 3) [12, 28, 30, 31]. The other 14 studies evaluating RLN injury reported no cases of permanent RLN injury [10, 11, 14-16, 21, 23, 25, 26].…”

“…In addition, Lobe and Wright [24] reported results in pediatric patients who underwent total thyroidectomy via a transaxillary endoscopic approach (n = 31). Subtotal thyroidectomy was performed in 5 studies (n = 550) [16,[25][26][27][28]. Four studies did not specify the surgical method used in the patients with GD (n = 110) [12,[29][30][31].…”