Thyroid Gland Surgery in Children and Adolescents - Indications, Results and Complications

Overview

The authors present a group of 77 children and adolescents who were operated in 1991 - 1998 at the Clinic ofOtorhinolaryngology and Surgery of Head and Neck of the First Medical Faculty Charles University, Chair ofOtorhinolaryngology of the Institute for Postgraduate Medical Training in Prague on account of thyroid disease.The group comprised 8 boys (10.4%) and 69 girls (89.6%). The sex ration (boys/girls) in the gr oup is 1 : 8.6.The ratio of boys and girls with non-malignant disease is 1 : 13 and in malignant thyroid tumours it is 1 : 4.3.Thyroid surgery was indicated on account of non-malignant diseases in 56 patients, most frequently it wasperformed on account of toxicosis (Grave-Basedow toxicosis, Hashitoxicosis, toxic adenoma) in 31 children(40.3%). The operation was indicated on account of nodular goitre in 8 patients (10.4%), single-node goitre wasthe cause of operation in 14 patients (18.2%). Two girls were recommended for surgery on account of Hashimoto’sthyroiditis and one girl on account of mechanical syndrome in diffuse goitre.A malignant tumour was found in 21 child patients (27.3%), i.e. in 4 boys and 17 girls. Most frequentlya papillary carcinoma was involved (16 cases). Follicular carcinoma was diagnosed in three patients and medullarycarcinoma in two.The authors summarize the indications for surgery of thyroid disease in children and adolescents. Treatmentof thyroid disease is team work. Surgery is indicated by a child endocrinologist in collaboration with a surgeonspecialized in thyroid surgery. The surgeon should master not only thyroid surgery but also surgery of the nodularsystem of the neck (selective cervical block dissection). Possible identification of the recurrent nerve by a surgicalmicroscope is a n advantage which is beyond doubt. Children and adolescents should be concentrated in departments where not only surgical but also endocrinological care is provided. In children with malignant disease collaborationof the child oncologist and subsequent oncological treatment in a department of nuclear medicine is essential.The authors summarize the findings on contemporary possibilities of surgical treatment of thyroid disease inchildren and adolescents. They draw attention to differences as regards indication and decision taking on the extentof surgery in children and adolescents.

Key words:
thyroid disease, indications for surgery, total thyroidectomy, selective cervical block dissection