Thyroidectomy in children: changing trends and surgical strategies.

BACKGROUND

Surgical thyroid pathology is an uncommon problem in children and due to environmental factors may be locally-specific. Until the mid-90's, Lower Silesia had been regarded as a region of endemic goiter but since then a better system of iodine prophylaxis has been introduced.

OBJECTIVES

To assess changing trends in the epidemiology of surgical thyroid diseases in children and to examine whether they have influenced potential alterations of operative strategies during the study period.

MATERIAL AND METHODS

The medical records of all children operated on for thyroid disease between 1993 and 2010 in the university pediatric surgical center were retrospectively reviewed. The data regarding the indications for thyroidectomy, details of surgical management and outcome were collected and analyzed in three periods of time 1993-1998, 1999-2004 and 2005-2010.

RESULTS

There were 46, 63 and 41 children operated on in the analyzed periods of time, respectively, with no significant differences regarding their age and gender. Preoperative thyroid ultrasound scan showed nodular lesions within the thyroid gland in 145 children (94.7%). The frequency of unilateral and bilateral nodular lesions was basically similar throughout the whole study. There has been a significant decrease of subtotal resections from around 63% in the first period to less than 16% in the other two periods of the study. The reverse trend can be clearly seen with regard to unilateral total lobectomy. Since 1999, total lobectomy or total thyroidectomy has been performed in more than 80% of the children. Nodular goiter was the most common indication for surgical operation followed by follicular adenoma. Malignant disease was recorded in 7 children (4.6%).

CONCLUSIONS

The gradual decrease of the number of children with surgical pathology of the thyroid gland seems to reflect an effective iodine prophylaxis. Depending on the extent of thyroid disease, unilateral lobectomy, either alone or coupled with partial or total resection of the contralateral lobe should be a standard surgical procedure in children.