Skip to main content
SpringerLink
Log in

Pediatric thyroid surgery: experience in 75 consecutive thyroidectomies

  • Head & Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Objectives

The main objective of this study is to report our experience in a university hospital in the surgical management of thyroid disease in pediatric patients. We also aim to analyze the results and evaluate the efficacy of fine-needle aspiration biopsy (FNAB) and frozen section analysis.

Methods

A retrospective review of thyroid surgeries from January 1997 to December 2017 was conducted. Patients aged under 18 who underwent total or partial thyroidectomy were included. The indication of the surgery, the investigation results, the surgical technique used and the final diagnosis were reviewed and analyzed.

Results

A total of 75 patients were included. 80% (n = 60) were females and 20% (n =  15) were males. The average age was 13.3 years ± 3.76 and age range was 3–18 years. The indication for thyroidectomy was thyroid nodule in 80% (n = 60), Grave’s disease in 13.3% (n = 10), multiple endocrine neoplasm type II (MEN II) in 6.7% (n. 5). FNAB was done in 42.7% (n = 32/75) with sensitivity and specificity of 62.50% and 94.4%, respectively, the positive predictive value was 83.3% and the negative predictive value was 85%. Frozen section, which is a quick intraoperative micro and/or macroscopic examination, was done in 66.7% (n = 50/75). It was malignant in 12% (n = 6/50) and was benign in 88% (n = 44/50). Among benign results, nine (n = 9/44) patients had malignant disease in final pathological diagnosis. Its sensitivity and specificity were 40% and 100%, respectively, the positive predictive value and the negative predictive value were 100% and 79.6%, respectively. Total thyroidectomy was done in 54.7% (n = 41/75) and partial thyroidectomy was done in 45.3% (n = 34/75). Of the 75 patients, 29.3% (n = 22) had thyroid carcinoma on final pathological analysis.

Conclusion

Thyroid diseases that require surgical intervention are rare in pediatric populations. However, when surgery is indicated, there is higher risk of malignancy compared to adults. Our study showed that FNAB has a lower specificity and sensitivity compared to adults, and that surgical decision should be made considering all investigations. We also showed that frozen section is considered primarily for papillary thyroid carcinoma but is not reliable for follicular carcinoma or Bethesda IV. Finally, thyroid surgery in children and adolescents must be part of global multidisciplinary management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Francis GL, Waguespack SG, Bauer AJ et al (2015) Management guidelines for children with thyroid nodules and differentiated thyroid cancer. Thyroid 25:716–759. https://doi.org/10.1089/thy.2014.0460

    Article  PubMed  PubMed Central  Google Scholar 

  2. David J. Brown JVB, Heider A (2015) Pediatric head and neck malignancies. In: Cummings pediatric otolaryngology. Elsevier/Saunders, Philadelphia, pp 272.2e–292.2e

    Google Scholar 

  3. Trahan J, Reddy A, Chang E et al (2016) Pediatric thyroid nodules: a single center experience. Int J Pediatr Otorhinolaryngol 87:94–97. https://doi.org/10.1016/j.ijporl.2016.06.011

    Article  PubMed  Google Scholar 

  4. Wémeau J-L, Sadoul J-L, Herbomez, Monpeyssen H, Tramalloni J, Leteurtre E, Borson-Chazot F, Caron P, Carnaille B, Léger J, Do C, Klein M, Raingeard I, Desailloud R, Leenhardt L (2018) Recommandations de la Société française d’endocrinologie pour la prise en charge des nodules thyroïdiens

  5. Niedziela M (2006) Pathogenesis, diagnosis and management of thyroid nodules in children. Endocr Relat Cancer 13:427–453. https://doi.org/10.1677/erc.1.00882

    Article  CAS  PubMed  Google Scholar 

  6. Cibas ES, Ali SZ (2009) The Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol 132:658–665. https://doi.org/10.1309/AJCPPHLWMI3JV4LA

    Article  PubMed  Google Scholar 

  7. Amrikachi M, Ponder TB, Wheeler TM et al (2005) Thyroid fine-needle aspiration biopsy in children and adolescents: experience with 218 aspirates. Diagn Cytopathol 32:189–192. https://doi.org/10.1002/dc.20197

    Article  PubMed  Google Scholar 

  8. Cooper DS, Doherty GM, Haugen BR et al (2009) Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214. https://doi.org/10.1089/thy.2009.0110

    Article  PubMed  Google Scholar 

  9. Layfield LJ, Cibas ES, Baloch Z (2010) Thyroid fine needle aspiration cytology: a review of the National Cancer Institute state of the science symposium. Cytopathology 21:75–85. https://doi.org/10.1111/j.1365-2303.2010.00750.x

    Article  CAS  PubMed  Google Scholar 

  10. Roy R, Kouniavsky G, Schneider E et al (2011) Predictive factors of malignancy in pediatric thyroid nodules. Surgery 150:1228–1233. https://doi.org/10.1016/j.surg.2011.09.023

    Article  PubMed  Google Scholar 

  11. Corrias A, Einaudi S, Chiorboli E et al (2001) Accuracy of fine needle aspiration biopsy of thyroid nodules in detecting malignancy in childhood: comparison with conventional clinical, laboratory, and imaging approaches. J Clin Endocrinol Metab 86:4644–4648. https://doi.org/10.1210/jcem.86.10.7950

    Article  CAS  PubMed  Google Scholar 

  12. Guevara N, Lassalle S, Benaim G et al (2015) Role of frozen section analysis in nodular thyroid pathology. Eur Ann Otorhinolaryngol Head Neck Dis 132:67–70. https://doi.org/10.1016/j.anorl.2014.02.006

    Article  CAS  PubMed  Google Scholar 

  13. Peng Y, Wang HH (2008) A meta-analysis of comparing fine-needle aspiration and frozen section for evaluating thyroid nodules. Diagn Cytopathol 36:916–920. https://doi.org/10.1002/dc.20943

    Article  PubMed  Google Scholar 

  14. LiVolsi VA, Baloch ZW (2005) Use and abuse of frozen section in the diagnosis of follicular thyroid lesions. Endocr Pathol 16:285–293. https://doi.org/10.1385/EP:16:4:285

    Article  PubMed  Google Scholar 

  15. Diesen DL, Skinner MA (2016) Head and neck tumors. In: Carachi R, Grosfeld JL (eds) The surgery of childhood tumors. Springer, Berlin, pp 441–480

    Chapter  Google Scholar 

  16. Burke JF, Sippel RS, Chen H (2012) Evolution of pediatric thyroid surgery at a tertiary medical center. J Surg Res 177:268–274. https://doi.org/10.1016/j.jss.2012.06.044

    Article  PubMed  PubMed Central  Google Scholar 

  17. Efremidou EI, Papageorgiou MS, Liratzopoulos N, Manolas KJ (2009) The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: a review of 932 cases. Can J Surg 52:6

    Google Scholar 

  18. Akkari M, Makeieff M, Jeandel C et al (2014) Thyroid surgery in children and adolescents: a series of 65 cases. Eur Ann Otorhinolaryngol Head Neck Dis 131:293–297. https://doi.org/10.1016/j.anorl.2013.11.009

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This study was not funded by any institution or any organization.

Author information

Authors and Affiliations

  1. Services d’ORL et Chirurgie Cervico Faciale & ORL pédiatrique, CHRU de TOURS, Université de TOURS, 37044, Tours cedex 9, France

    Ali Alkhars, Moumainn Abouzayd, Charles-Edouard Rouf, David Bakhos, Soizick Pondaven-Letourmy, Sylvain Moriniere & Emmanuel Lescanne

  2. Service de Chirurgie Pédiatrique Viscérale et Plastique, CHRU de TOURS, Université de TOURS, 37044, Tours cedex 9, France

    Hubert Lardy

Authors
  1. Ali Alkhars
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Moumainn Abouzayd
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Charles-Edouard Rouf
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hubert Lardy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David Bakhos
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Soizick Pondaven-Letourmy
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sylvain Moriniere
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Emmanuel Lescanne
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ali Alkhars.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest concerning this article.

Research involving human participants and/ or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alkhars, A., Abouzayd, M., Rouf, CE. et al. Pediatric thyroid surgery: experience in 75 consecutive thyroidectomies. Eur Arch Otorhinolaryngol 276, 217–222 (2019). https://doi.org/10.1007/s00405-018-5188-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-018-5188-9

Keywords

Search

Navigation