Contemporary Review of Pediatric Thyroid Surgery
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PURPOSE: Pediatric thyroid cancer is uncommon and, despite its relative aggressiveness, prognosis is favorable if treated appropriately. Our study is the largest contemporary review to characterize the presentation, treatment, and outcomes in all pediatric patients requiring thyroid resections from two medical centers. We examined the factors associated with complications, the accuracy of FNA, and management of follicular lesions. METHODS: After IRB approval, we reviewed all available data on pediatric patients undergoing thyroid operations at two pediatric children's centers between 2003 and 2014. We examined demographic factors, history, physical, imaging, operative course, and follow-up. RESULTS: We identified 97 patients with a median age of 13.5 years, 86% females, 75% Caucasian, 6% with a personal history of cancer and radiation, and 13% family history of thyroid cancer (12% MEN-2A) with a mean follow up of 33 months. Patients underwent total thyroidectomy (44%), near total/subtotal thyroidectomy (18%), and lobectomy (38%) with 37% having lymph node dissections and 24% having a parathyroid autotransplant. Malignancy was diagnosed in 42% of patients with 39% having malignant lymph node and 2% distant metastases. 63% percent of patients with cancer received postoperative I131. Risk factors for complications were palpable nodes, history of radiation, malignancy, and type of surgery (p<0.05). Thirteen percent of patients had complications FNA was performed on 69% of patients with a sensitivity and specificity of 95% and 100%, and a PPV and NPV of 100% and 88%, respectively. Follicular FNA was found in 32 patients. 21 patients had lobectomies after which 4 required completion thyroidectomies for malignancy. Eleven patients had total/near total thyroidectomies for goiter, bilateral lesions, or history of radiation. Patients with follicular FNA had a 34% risk of carcinoma on final pathology. CONCLUSIONS: Risk factors for complications were palpable nodes, history of radiation, malignancy, and type of surgery. FNA was a reliable tool for in evaluating thyroid nodules in children. Total thyroidectomies, subtotal thyroidectomies, and lymph node dissections were associated with an increased rate of complication as opposed to lobectomies. In the case of follicular lesions, lobectomy may be performed understanding the possible need for completion thyroidectomy.