Skip to main content

Advertisement

SpringerLink
Log in

Surgical Management of Thyroid Disease in Children

  • Pediatric Otolaryngology (I Bruce, Section Editor)
  • Published:
Current Otorhinolaryngology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To provide a comprehensive, up-to-date guide for the surgical management of the most common malignant and benign thyroid diseases within the pediatric population.

Recent Findings

26.4% of nodules are malignant in the pediatric population. Concerning ultrasound features of hypoechogenicity, irregular margins, increased intranodular blood flow, or microcalcifications should prompt FNA, while size criteria is less important. The Bethesda System is effective in stratifying risk in pediatric nodules. The role of molecular genetic testing to guide patient management is emerging. Total thyroidectomy has become more frequent in the treatment of differentiated thyroid cancer due to its aggressive nature in the pediatric population and concern for recurrence. The role of adjunctive radiofrequency iodine ablation and the impact of extensive resection on survival are controversial.

Summary

Management of pediatric thyroid disease can be complex and should be managed by a multidisciplinary team with an experienced, high-volume surgeon.

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

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Francis GL, Waguespack SG, Bauer AJ, Angelos P, Benvenga S, Cerutti JM, et al. Management guidelines for children with thyroid nodules and differentiated thyroid cancer. Thyroid. 2015;25(7):716–59. The first task force created guidelines for management of thyroid disease specifically in children as placed forward by the American Thyroid Association.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Guille JT, Opoku-Boateng A, Thibeault SL, Chen H. Evaluation and management of the pediatric thyroid nodule. Oncologist. 2015;20(1):19–27. https://doi.org/10.1634/theoncologist.2014-0115.

    Article  PubMed  Google Scholar 

  3. Buryk MA, Simons JP, Picarsic J, Monaco SE, Ozolek JA, Joyce J, et al. Can malignant thyroid nodules be distinguished from benign thyroid nodules in children and adolescents by clinical characteristics? A review of 89 pediatric patients with thyroid nodules. Thyroid. 2015;25(4):392–400. https://doi.org/10.1089/thy.2014.0312.

    Article  CAS  PubMed  Google Scholar 

  4. Ly S, Frates MC, Benson CB, Peters HE, Grant FD, Drubach LA, et al. Features and outcome of autonomous thyroid nodules in children: 31 consecutive patients seen at a single center. J Clin Endocrinol Metab. 2016;101(10):3856–62. https://doi.org/10.1210/jc.2016-1779.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. • Lim-Dunham JE, Erdem Toslak I, Alsabban K, Aziz A, Martin B, Okur G, et al. Ultrasound risk stratification for malignancy using the 2015 American Thyroid Association Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer. Pediatr Radiol. 2017;47(4):429–36. Recent review evaluating the reproducibility of the ATA recommendations for fine needle aspiration of thyroid nodules in children based on imaging characteristics, and how it translates to estimating malignancy risk.

    Article  PubMed  Google Scholar 

  6. Gupta A, Ly S, Castroneves LA, Frates MC, Benson CB, Feldman HA, et al. A standardized assessment of thyroid nodules in children confirms higher cancer prevalence than in adults. J Clin Endocrinol Metab. 2013;98(8):3238–45. https://doi.org/10.1210/jc.2013-1796.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Cibas ES, Ali SZ. The Bethesda system for reporting thyroid cytopathology. Thyroid. 2009;19(11):1159–65. https://doi.org/10.1089/thy.2009.0274.

    Article  PubMed  Google Scholar 

  8. Rossi ED, Martini M, Cenci T, Capodimonti S, Larocca LM. The role of thyroid FNA cytology in pediatric malignant lesions: an overview of the literature. Cancer 2017.

  9. Monaco SE, Pantanowitz L, Khalbuss WE, Benkovich VA, Ozolek J, Nikiforova MN, et al. Cytomorphological and molecular genetic findings in pediatric thyroid fine-needle aspiration. Cancer Cytopathol. 2012;120(5):342–50. https://doi.org/10.1002/cncy.21199.

    Article  PubMed  Google Scholar 

  10. Amirazodi E, Propst EJ, Chung CT, Parra DA, Wasserman JD. Pediatric thyroid FNA biopsy: outcomes and impact on management over 24 years at a tertiary care center. Cancer Cytopathol. 2016;124(11):801–10. https://doi.org/10.1002/cncy.21750.

    Article  PubMed  Google Scholar 

  11. Noureldine SI, Najafian A, Aragon Han P, Olson MT, Genther DJ, Schneider EB, et al. Evaluation of the effect of diagnostic molecular testing on the surgical decision-making process for patients with thyroid nodules. JAMA Otolaryngol Head Neck Surg. 2016;142(7):676–82. https://doi.org/10.1001/jamaoto.2016.0850.

    Article  PubMed  Google Scholar 

  12. Canfarotta M, Moote D, Finck C, Riba-Wolman R, Thaker S, Lerer TJ, et al. McGill thyroid nodule score in differentiating benign and malignant pediatric thyroid nodules: a pilot study. Otolaryngol Head Neck Surg 2017:194599817715629.

  13. Diesen DL, Skinner MA. Pediatric thyroid cancer. Semin Pediatr Surg. 2012;21(1):44–50.

    Article  PubMed  Google Scholar 

  14. Rivkees SA, Mazzaferri EL, Verburg FA, Reiners C, Luster M, Breuer CK, et al. The treatment of differentiated thyroid cancer in children: emphasis on surgical approach and radioactive iodine therapy. Endocr Rev. 2011;32(6):798–826. https://doi.org/10.1210/er.2011-0011.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Suh CH, Baek JH, Choi YJ, Lee JH. Performance of CT in the preoperative diagnosis of cervical lymph node metastasis in patients with papillary thyroid cancer: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2017;38(1):154–61. https://doi.org/10.3174/ajnr.A4967.

    Article  CAS  PubMed  Google Scholar 

  16. Stulak JM, Grant CS, Farley DR, Thompson GB, van Heerden JA, Hay ID, et al. Value of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid cancer. Arch Surg. 2006;141(5):489–94; discussion 94-6. https://doi.org/10.1001/archsurg.141.5.489.

    Article  PubMed  Google Scholar 

  17. Spinelli C, Strambi S, Rossi L, Bakkar S, Massimino M, Ferrari A, et al. Surgical management of papillary thyroid carcinoma in childhood and adolescence: an Italian multicenter study on 250 patients. J Endocrinol Investig. 2016;39(9):1055–9. https://doi.org/10.1007/s40618-016-0474-0.

    Article  CAS  Google Scholar 

  18. Sugino K, Nagahama M, Kitagawa W, Shibuya H, Ohkuwa K, Uruno T, et al. Papillary thyroid carcinoma in children and adolescents: long-term follow-up and clinical characteristics. World J Surg. 2015;39(9):2259–65. https://doi.org/10.1007/s00268-015-3042-4.

    Article  PubMed  Google Scholar 

  19. • Nice T, Pasara S, Goldfarb M, Doski J, Goldin A, Gow KW, et al. Pediatric papillary thyroid cancer >1 cm: is total thyroidectomy necessary? J Pediatr Surg. 2015;50(6):1009–13. Recent review of 3861 pediatric papillary thyroid cancer patients with tumor size > 1cm using the national cancer database to determine the overall survival rates for patients undergoing total thyroidectomy versus partial thyroidectomy.

    Article  PubMed  Google Scholar 

  20. Raval MV, Bentrem DJ, Stewart AK, Ko CY, Reynolds M. Utilization of total thyroidectomy for differentiated thyroid cancer in children. Ann Surg Oncol. 2010;17(10):2545–53. https://doi.org/10.1245/s10434-010-1083-3.

    Article  PubMed  Google Scholar 

  21. Hay ID, Gonzalez-Losada T, Reinalda MS, Honetschlager JA, Richards ML, Thompson GB. Long-term outcome in 215 children and adolescents with papillary thyroid cancer treated during 1940 through 2008. World J Surg. 2010;34(6):1192–202. https://doi.org/10.1007/s00268-009-0364-0.

    Article  PubMed  Google Scholar 

  22. Popovtzer A, Shpitzer T, Bahar G, Feinmesser R, Segal K. Thyroid cancer in children: management and outcome experience of a referral center. Otolaryngol Head Neck Surg. 2006;135(4):581–4. https://doi.org/10.1016/j.otohns.2006.04.004.

    Article  PubMed  Google Scholar 

  23. Demidchik YE, Demidchik EP, Reiners C, Biko J, Mine M, Saenko VA, et al. Comprehensive clinical assessment of 740 cases of surgically treated thyroid cancer in children of Belarus. Ann Surg. 2006;243(4):525–32. https://doi.org/10.1097/01.sla.0000205977.74806.0b.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Lazar L, Lebenthal Y, Steinmetz A, Yackobovitch-Gavan M, Phillip M. Differentiated thyroid carcinoma in pediatric patients: comparison of presentation and course between pre-pubertal children and adolescents. J Pediatr. 2009;154(5):708–14. https://doi.org/10.1016/j.jpeds.2008.11.059.

    Article  PubMed  Google Scholar 

  25. Beasley NJ, Lee J, Eski S, Walfish P, Witterick I, Freeman JL. Impact of nodal metastases on prognosis in patients with well-differentiated thyroid cancer. Arch Otolaryngol Head Neck Surg. 2002;128(7):825–8. https://doi.org/10.1001/archotol.128.7.825.

    Article  PubMed  Google Scholar 

  26. Mihailovic J, Nikoletic K, Srbovan D. Recurrent disease in juvenile differentiated thyroid carcinoma: prognostic factors, treatments, and outcomes. J Nucl Med. 2014;55(5):710–7. https://doi.org/10.2967/jnumed.113.130450.

    Article  PubMed  Google Scholar 

  27. Handkiewicz-Junak D, Wloch J, Roskosz J, Krajewska J, Kropinska A, Pomorski L, et al. Total thyroidectomy and adjuvant radioiodine treatment independently decrease locoregional recurrence risk in childhood and adolescent differentiated thyroid cancer. J Nucl Med. 2007;48(6):879–88. https://doi.org/10.2967/jnumed.106.035535.

    Article  CAS  PubMed  Google Scholar 

  28. Hong JC, Seo JW, Jang AL, Suh SH, Pak MG, Han SH, et al. The utility of intra-operative frozen section for the evaluation of microscopic extrathyroidal extension in papillary thyroid carcinoma. Clin Otolaryngol. 2017;42(6):1167–71. https://doi.org/10.1111/coa.12843.

    Article  CAS  PubMed  Google Scholar 

  29. Nixon IJ, Wang LY, Ganly I, Patel SG, Morris LG, Migliacci JC, et al. Outcomes for patients with papillary thyroid cancer who do not undergo prophylactic central neck dissection. Br J Surg. 2016;103(3):218–25. https://doi.org/10.1002/bjs.10036.

    Article  CAS  PubMed  Google Scholar 

  30. Enomoto K, Enomoto Y, Uchino S, Yamashita H, Noguchi S. Follicular thyroid cancer in children and adolescents: clinicopathologic features, long-term survival, and risk factors for recurrence. Endocr J. 2013;60(5):629–35. https://doi.org/10.1507/endocrj.EJ12-0372.

    Article  PubMed  Google Scholar 

  31. Golpanian S, Tashiro J, Sola JE, Allen C, Lew JI, Hogan AR, et al. Surgically treated pediatric nonpapillary thyroid carcinoma. Eur J Pediatr Surg. 2016;26(6):524–32. https://doi.org/10.1055/s-0035-1569150.

    Article  PubMed  Google Scholar 

  32. Balachandar S, La Quaglia M, Tuttle RM, Heller G, Ghossein RA, Sklar CA. Pediatric differentiated thyroid carcinoma of follicular cell origin: prognostic significance of histologic subtypes. Thyroid. 2016;26(2):219–26. https://doi.org/10.1089/thy.2015.0287.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Nagy R, Ganapathi S, Comeras I, Peterson C, Orloff M, Porter K, et al. Frequency of germline PTEN mutations in differentiated thyroid cancer. Thyroid. 2011;21(5):505–10. https://doi.org/10.1089/thy.2010.0365.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Spinelli C, Strambi S, Rossi L, Elisei R, Massimino M. Surgical management of medullary thyroid carcinoma in pediatric age. Curr Pediatr Rev. 2016;12(4):280–5. https://doi.org/10.2174/1573396313666161111120936.

    Article  PubMed  Google Scholar 

  35. Wells SA, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid. 2015;25(6):567–610. https://doi.org/10.1089/thy.2014.0335.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Wells SA, Pacini F, Robinson BG, Santoro M. Multiple endocrine neoplasia type 2 and familial medullary thyroid carcinoma: an update. J Clin Endocrinol Metab. 2013;98(8):3149–64. https://doi.org/10.1210/jc.2013-1204.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Gagel RF, Marx SJ. “Multiple endocrine neoplasia.” Williams Textbook of Endocrinology, Chapter 40, 11th ed., Philadelphia, and Eng C, Clayton D, et al. 2008.

  38. Grubbs EG, Gagel RF. My, How Things Have Changed in Multiple Endocrine Neoplasia Type 2A! J Clin Endocrinol Metab. 2015;100(7):2532–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Iacobone M, Citton M, Viel G, Schiavone D, Torresan F. Surgical approaches in hereditary endocrine tumors. Updat Surg. 2017;69(2):181–91. https://doi.org/10.1007/s13304-017-0451-y.

    Article  Google Scholar 

  40. Elisei R, Romei C, Renzini G, Bottici V, Cosci B, Molinaro E, et al. The timing of total thyroidectomy in RET gene mutation carriers could be personalized and safely planned on the basis of serum calcitonin: 18 years experience at one single center. J Clin Endocrinol Metab. 2012;97(2):426–35. https://doi.org/10.1210/jc.2011-2046.

    Article  CAS  PubMed  Google Scholar 

  41. Rivkees SA. Pediatric Graves’ disease: management in the post-propylthiouracil era. Int J Pediatr Endocrinol. 2014;2014(1):10. https://doi.org/10.1186/1687-9856-2014-10.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Léger J, Carel JC. Hyperthyroidism in childhood: causes, when and how to treat. J Clin Res Pediatr Endocrinol. 2013;5(Suppl 1):50–6.

    PubMed  PubMed Central  Google Scholar 

  43. Minamitani K, Sato H, Ohye H, Harada S, Arisaka O, Committee on Pharmaceutical Affairs JSfPE, and the Pediatric Thyroid Disease Committee, J.pan Thyroid Association (Taskforce for the Revision of the Guidelines for the Treatment of Childhood-Onset Graves’ Disease). Guidelines for the treatment of childhood-onset Graves’ disease in Japan, 2016. Clin Pediatr Endocrinol. 2017;26(2):29–62. https://doi.org/10.1297/cpe.26.29.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Rivkees SA. 63 years and 715 days to the “boxed warning”: unmasking of the propylthiouracil problem. Int J Pediatr Endocrinol 2010;2010.

  45. Elfenbein DM, Katz M, Schneider DF, Chen H, Sippel RS. Thyroidectomy for Graves’ disease in children: indications and complications. J Pediatr Surg. 2016;51(10):1680–3. https://doi.org/10.1016/j.jpedsurg.2016.03.009.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Breuer CK, Solomon D, Donovan P, Rivkees SA, Udelsman R. Effect of patient age on surgical outcomes for Graves’ disease: a case-control study of 100 consecutive patients at a high volume thyroid surgical center. Int J Pediatr Endocrinol. 2013;2013(1):1. https://doi.org/10.1186/1687-9856-2013-1.

    Article  PubMed  PubMed Central  Google Scholar 

  47. • Kundel A, Thompson GB, Richards ML, Qiu LX, Cai Y, Schwenk FW, et al. Pediatric endocrine surgery: a 20-year experience at the Mayo Clinic. J Clin Endocrinol Metab. 2014;99(2):399–406. Recent review conducted at the Mayo Clinic reporting their operative experience and outcomes of 241 cases of children < 19 years old performed by high-volume endocrine surgeons.

    Article  CAS  PubMed  Google Scholar 

  48. Burke JF, Sippel RS, Chen H. Evolution of pediatric thyroid surgery at a tertiary medical center. J Surg Res. 2012;177(2):268–74. https://doi.org/10.1016/j.jss.2012.06.044.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Breuer C, Tuggle C, Solomon D, Sosa JA. Pediatric thyroid disease: when is surgery necessary, and who should be operating on our children? J Clin Res Pediatr Endocrinol. 2013;5(Suppl 1):79–85.

    PubMed  PubMed Central  Google Scholar 

  50. Grant CS, Stulak JM, Thompson GB, Richards ML, Reading CC, Hay ID. Risks and adequacy of an optimized surgical approach to the primary surgical management of papillary thyroid carcinoma treated during 1999-2006. World J Surg. 2010;34(6):1239–46. https://doi.org/10.1007/s00268-009-0307-9.

    Article  PubMed  Google Scholar 

  51. Kluijfhout WP, van Beek DJ, Verrijn Stuart AA, Lodewijk L, Valk GD, van der Zee DC, et al. Postoperative complications after prophylactic thyroidectomy for very young patients with multiple endocrine neoplasia type 2: retrospective cohort analysis. Medicine (Baltimore). 2015;94(29):e1108. https://doi.org/10.1097/MD.0000000000001108.

    Article  Google Scholar 

  52. Schietroma M, Cecilia EM, Carlei F, Sista F, De Santis G, Lancione L, et al. Dexamethasone for the prevention of recurrent laryngeal nerve palsy and other complications after thyroid surgery: a randomized double-blind placebo-controlled trial. JAMA Otolaryngol Head Neck Surg. 2013;139(5):471–8. https://doi.org/10.1001/jamaoto.2013.2821.

    Article  PubMed  Google Scholar 

  53. Piccirillo JF, Bauchner H. Expression of concern: Schietroma M, Cecilia EM, Carlei F, Sista F, De Santis G, Lancione L, Amicucci G. Dexamethasone for the prevention of recurrent laryngeal nerve palsy and other complications after thyroid surgery: a randomized double-blind placebo-controlled trial. JAMA Otolaryngol Head Neck Surg 2013;139(5):471–478. doi:10.1001/jamaoto.2013.2821. JAMA Otolaryngol Head Neck Surg. 2017; https://doi.org/10.1001/jamaoto.2017.1641.

  54. Chung TK, Rosenthal EL, Porterfield JR, Carroll WR, Richman J, Hawn MT. Examining national outcomes after thyroidectomy with nerve monitoring. J Am Coll Surg. 2014;219(4):765–70. https://doi.org/10.1016/j.jamcollsurg.2014.04.013.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Stack BC, Bimston DN, Bodenner DL, Brett EM, Dralle H, Orloff LA, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Disease State clinical review: postoperative hypoparathyroidism—definitions and management. Endocr Pract. 2015;21(6):674–85. https://doi.org/10.4158/EP14462.DSC.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA

    Roberto Solis

  2. Department of Otolaryngology- Head and Neck Surgery, University of Texas- Southwestern, Dallas, TX, USA

    Allison Ordemann & Eric E. Berg

  3. Department of Otolaryngology, Head and Neck Surgery, UT Southwestern and Children’s Medical Center Dallas, 2350 North Stemmons Freeway ENT Clinic, 6th floor, Dallas, TX, 75207, USA

    Eric E. Berg

Authors
  1. Roberto Solis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Allison Ordemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eric E. Berg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eric E. Berg.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Pediatric Otolaryngology

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Solis, R., Ordemann, A. & Berg, E.E. Surgical Management of Thyroid Disease in Children. Curr Otorhinolaryngol Rep 6, 56–63 (2018). https://doi.org/10.1007/s40136-018-0189-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40136-018-0189-1

Keywords

Search

Navigation