Thyroid surgery in children and young adults: potential overtreatment and complications

Julia I Staubitz,Alicia Poplawski,Julia Bode,Thomas J Musholt,Felix Watzka,Hauke Lang,Joachim Pohlenz

doi:10.1007/s00423-020-01896-x

Abstract

PurposeThyroid nodules in the pediatric population are more frequently associated with malignant thyroid disease than in adult cohorts. Yet, there is a potential risk of surgical overtreatment. With this single center study, an analysis of potential overtreatment for suspected malignant thyroid disease in children and young adults was aimed for.MethodsIn a period from 2005 to 2018, 155 thyroid operations in children and young adults performed at the University Medical Center Mainz, Germany, were analyzed (patient age 3–20 years, 117 female). Cases were categorized for preoperative diagnosis: non-malignant (group I, n = 45) and malignant thyroid disease (group II, n = 110). Postoperative parameters (histology, complication rates) were assessed and compared between groups.Results91.1% of group I were histologically benign. 44.5% of group II harbored malignancy. Permanent hypoparathyroidism was documented in group I (2.7%) and in group II (1.4%, p = 1.000). Wound infections were absent in group I but observed in group II (0.9%, p = 1.000). Transient vocal cord palsy was recorded only in group I (2.3%, 2/85 vs. 0/177 nerves at risk, p = 0.104). Permanent vocal cord palsies were absent.ConclusionPreoperative diagnoses were correct in over 90% of group I and in nearly 45% of group II. The high proportion of carcinomas in group II ruled out the issue of potential overtreatment. The risk of severe postoperative complications was equally low in both patient groups.

Highlights

In children and adolescents, thyroid carcinoma is among the most frequently observed tumor entities of the endocrine system [1]
The aim of the study was to answer the questions if there is overtreatment for thyroid nodules, and whether potential overtreatment leads to an increased rate of postoperative complications
In 14.2%, genetic disorders affecting the thyroid gland were recorded (Table 1). Those were in 40.9% MEN2A, RET codon 634 mutation (9), in 18.2% Pendred syndrome (4), in 18.2% PTEN hamartoma tumor syndrome, in 9.1% (2) TPO gene mutation, in 9.1% MEN2, codon 804 mutation (2) and in 4.5% (1) DICER1 mutation

Summary

Introduction

Thyroid carcinoma is among the most frequently observed tumor entities of the endocrine system [1]. In 90% of pediatric thyroid carcinoma, papillary thyroid carcinoma (PTC) is the underlying entity, which—in comparison with the adult population—presents more frequently with multifocal disease and metastases to regional neck lymph nodes [7,8,9,10,11]. Medullary thyroid carcinoma (MTC) plays a key role in individuals suffering from multiple endocrine neoplasia (MEN) syndrome, whereas sporadic cases of MTC are infrequent [4, 8, 12]. Even though— compared with the adult population—the literature suggests that thyroid nodules in children and adolescents are more frequently associated with malignant disease [13, 14]; there is yet a risk of surgical overtreatment.

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