Pediatric thyroidectomy is an uncommon procedure and can be useful for the treatment of a number of different indications including medullary thyroid carcinoma (MTC), according to a retrospective analysis published in the Journal of Pediatric Surgery. The study included 87 patients who received thyroidectomies from April 1995 to January 2021.

“Thyroidectomy in pediatric patients is relatively uncommon and is associated with a greater risk of complications than in adults,” the authors said.

Nine patients (10.3% of patients included in the study) with multiple endocrine neoplasm type 2A (MEN2A) received prophylactic total thyroidectomy. Of these patients, 44% were found to have medullary thyroid microcarcinomas while another 44% had C-cell hyperplasia.


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In addition to prophylaxis for patients with MEN2A syndrome, patients also received thyroidectomies for several other indications including benign thyroid nodules or a multinodular goiter (26.4%), thyroid malignancy (23.0%), and refractory Graves’ disease (40.2%).

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Several operative complications were found during the study as well. These complications included immediate hypocalcemia which occurred in 32% of patients and permanent hypoparathyroidism which occurred in 8% of patients. The authors mentioned that autotransplantation of the parathyroid glands has been used more liberally at their hospital if any trauma is suspected, which has reduced the risk of hypoparathyroidism.

Transient vocal cord palsy was observed in 3% of patients which resolved within 5 months of surgery. Further analysis revealed that the use of recurrent laryngeal nerve monitoring during surgery resulted in a statistically lower rate of vocal cord palsy (P =.022).

A total of 92 thyroidectomies across the 87 patients were performed. Of these, 66 were total thyroidectomies while 26 were hemithyroidectomies (12 right sides and 14 left sides). The median operation time for total thyroidectomies was 134 minutes while the median was 65 minutes for hemithyroidectomies.

The median follow-up time during the study was 11.3 years. During this time, the median disease-free survival was 13.7 years for patients with well-differentiated thyroid carcinomas.

Reference

Yeung F, Wong KP, Lang BHH, Chung PHY, Wong KKY. Paediatric thyroidectomy: when and why? A 25-year institutional experience. J Pediatr Surg. Published online March 13, 2022. doi:10.1016/j.jpedsurg.2022.02.026