[Surgical treatment of thyroid diseases in children].
In order to review the experience of a single institution with thyroid surgery and identify prognostic factors, we did a retrospective chart review of all patients who underwent thyroid surgery between 1980 and 1995. Fifty patients, 32 girls and 18 boys, underwent thyroid surgery. Clinical presentation include a thyroid nodule (36 patients), a family history of MEN syndrome with a positive pentagastrin stimulation test (10), diffuse nodular goitre (3) and a neonatal cervical mass (1). Radiologic investigation include ultrasonography in 58% of cases, radionucleide imaging in 70% of cases. The mean age at surgery was 13.3 years and the delay between onset of symptoms and diagnostic was 13 months. Twenty-one patients had a lobectomy +/- isthmectomy, 19 had a total thyroidectomy and 10 had a subtotal thyroidectomy. Nine patients required a second surgery to complete the surgical treatment, and perform a total or near total thyroidectomy when the final pathology showed a carcinoma. A well differentiated carcinoma was found in 52% of the patients, a medullary carcinoma in 20% and a benign lesion in 28% of cases. Nine patients had local or distant metastases at initial surgery. Post-op treatment consisted of suppressive hormonotherapy in all cases of cancer and radioactive iodine when recurrence occurred in 24% of patients and when metastasis where present. Survival remained at 100%.


CONCLUSIONS
Thyroid nodules should be rapidly investigated in children because of a high potential of cancerous lesions. With an aggressive surgical treatment and post-op I131 for recurrent lesions and metastasis the prognostic remains excellent.
Giroux
M
M
Service de Chirurgie Générale Pédiatrique, Hôpital Sainte-Justine, Montréal, Québec, Canada.
Saint-Vil
D
D
Desjardins
J G
JG
D000293:Adolescent; D018276:Carcinoma, Medullary / Q000473:pathology / Q000601:surgery; D018265:Carcinoma, Papillary, Follicular / Q000473:pathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D013959:Thyroid Diseases / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery; D016606:Thyroid Nodule / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods*