Management of childhood thyroid nodules: Surgical and endocrinological findings in a large group of cases

Objective: the management of childhood thyroid nodules is still a big challenge for clinicians. in this study,we aimed to present our surgical and endocrinological experience in more than one hundred pediatric cases. methods: a retrospective analysis of patients admitted with a thyroid nodule between 2006 and 2014 was performed. detailed ultrasonography and fine-needle aspiration biopsy (fnab) were the cornerstones of the diagnostic approach. results: one hundred-three children (72 female,31 male) with a mean age of 13.1±3.6 years (3-18 years) were admitted to our center. management strategy was surgery in 58 patients and follow-up in 45 patients. mean nodule size was 17±12.7 mm (2-45 mm). the diagnoses were listed as benign solitary nodule (48 patients),thyroid carcinoma (26 patients),multinodular goiter (23 patients),hashimoto thyroiditis (4 patients),and graves’ disease (2 patients). surgical procedures were nodulectomy/lobectomy (32 patients),total thyroidectomy (tt) (13 patients),or tt+ neck dissection (13 patients). the rate of malignancy was 25% in the total group and 44% in the surgery group. the malignancy rate was higher in patients younger than 12 years compared to older children (41% vs. 17%,p=0.040). metastasis was seen in 38% of the malignant nodules. postoperative complications were transient hypocalcemia (8%),permanent hypocalcemia (1.7%),and unilateral vocal cord paralysis (1.7%). recurrence or mortality was not encountered in the 5.4±1.2-year follow-up period. conclusion: thyroid nodule in a child requires an aggressive diagnostic approach due to increased risk of malignancy and metastasis. intraoperative frozen section examination must be done as a useful adjunct to determine the surgical strategy. incidence of complications is small in thyroid surgery when performed by experienced surgeons. © 2017 by turkish pediatric endocrinology and diabetes society.