Surgical aspects of diseases of the thyroid gland in childhood.

The treatment of juvenile struma is the domain of the pediatrician, and operations are rarely necessary, even in struma-endemic regions. An absolute indication for surgery is diagnosed or suspected struma maligna: relative indications are hyperthyroidism and euthyroid goiter. The operative procedure in benign thyroid diseases is based on the pathogenesis: a tissue-saving technique is mandatory to prevent postoperative hypothyroidism. Therapeutic strategy in malignant diseases, i.e., the radicality of surgical and postoperative management, depends, as in adults, on the prognostic relevance of variable parameters.