• Indication
• Paediatric
• Thyroidectomy

Objective Paediatric thyroid diseases requiring surgery is uncommon and is associated with a greater risk of complications than in adults. At present, the research to paediatric thyroidectomy is not adequate enough and less complete than in adults. Most of the published papers concentrated on one of these paediatric thyroid disorders. Our paediatric series were retrospectively analyzed to study the indications for thyroidectomy in paediatric patients.
Patients and methods From January 2002 to December 2010, 253 paediatric patients (no more than 18 years old) with thyroid diseases underwent thyroid operations at the Department of Surgery, University of Pisa. Data were collected from patient medical records, and a database was established to record sex, age, type of operation, histological diagnosis, tumor size, tumor capsule infiltration, thyroid capsule infiltration, multifocality, bilaterality, node metastases and TNM stages. These data were retrospectively analyzed to try to analyze the indications for thyroid surgery in paediatric patients.
Results In cases of thyroid malignancy total thyroidectomy without lymph-node dissection was performed in 75 cases, whereas a lymph-node dissection was performed in 72 cases. 45 patients with follicular adenoma underwent near total thyroidetomy or total thyroidectomy. 33 patients underwent near total thyroidetomy or total thyroidectomy for Graves’ disease. Lobectomies were performed in 28 patients with nodular goiter.
There were no injuries to the recurrent laryngeal nerve (RLN). Hypocalcemia was the most common postoperative complication, occurring in 52 patients. All patients had normalization of their calcium levels within 3 months postoperatively.
No patient showed any unexpected diagnosis, and all the preoperative indications were histologically confirmed except one MTC patient was diagnosed c cell hyperplasia postoperatively. Six pathological subtypes of PTC were present.
In all thyroid diseases, a female predominance is evident. When further analyzing the different age-groups in patients with differentiated thyroid cancer, this predominance is still observed both in the group 0～12 and in the adolescent group 13～18.
In all thyroid diseases, a progressive incidence of surgery is showed from younger ages to older ones. This progressive incidence is still observed in patients with differentiated thyroid cancer.
Mean tumor size in PTC, FTC and MTC was 2.2 cm, 3.3 cm and 0.8 cm, respectively. Tumor capsule infiltration was presented in 78.6% of PTC, 100% of FTC and 66.7% of MTC, whereas infiltration of the thyroid capsule only occurred in 45% of PTC cases. Lymph-node metastases were found in 42.0% of PTC, 0% of FTC and 16.7% of MTC. Among variants of PTC, CV demonstrated the majority of cases of T3 or T4 stages. DSV and FV respectively had the highest and the least proportion of T3 stage.
PTC showed more lymph-node metastases than FTC and MTC. Unilateral or bilateral lymph-node metastases occurred in 31.3% of PTC. 98.2% of lymph-node metastases occurred in PTC cohort. Among variants of PTC, CV demonstrated the majority of metastases. DSV and FV respectively had the highest and the least tendency of metastases.
Conclusions Indications for thyroidectomy in paediatric patients include thyroid cancer, Graves’ disease and non-cancerous nodules, and thyroid cancer accounts for the majority of the indications. Among the paediatric population, female sex and pubertal age are the most common targets for thyroid disorders. Female sex and pubertal age are risk factors of paediatric thyroid disorders. A paediatric surgeon is not essential when dealing with thyroid surgery in children, but the results are affected by the experience of the surgeon dealing with thyroid surgery.
From an oncological point of view, our study confirms that papillary thyroid carcinoma in children shows more aggressiveness, higher stage at presentation, and is more prone to present with lymph-node metastases than both follicular and medullary thyroid carcinoma, and than the same disease in the adult population. In particular, the diffuse sclerosing variant shows the most aggressive features, and the follicular one seems to have the less aggressive features.