title: Thyroid surgery in children and adolescents: a series of 65 cases.
abstract: OBJECTIVE
  To describe the specificities and complications of thyroid surgery in children and adolescents.
  
  
  METHODS
  This retrospective study was based on 64 patients under the age of 18 who underwent thyroid surgery between January 2004 and March 2012, with two operations in one case. The following data were analysed: anatomical variants of the recurrent laryngeal nerve, postoperative recurrent laryngeal nerve paralysis rate, postoperative hypoparathyroidism rate, and histological results.
  
  
  RESULTS
  Two cases of right non-recurrent inferior laryngeal nerve were observed (2.2% of the 93 recurrent laryngeal nerves dissected). One case of persistent left recurrent laryngeal nerve paralysis was observed (1.1%) despite intraoperative recurrent laryngeal nerve monitoring. Eight cases of immediate postoperative hypocalcaemia were observed (23.5% of the 34 total thyroidectomies) and permanent hypocalcaemia was observed in 5 cases (14.7%) with a significantly lower immediate postoperative serum calcium than in the case of transient hypocalcaemia (P=0.035). Among the 11 patients operated for familial medullary thyroid carcinoma (MTC), 36.3% presented one or more sites of C-cell carcinoma. Among the 32 patients operated for thyroid nodule, 6.3% presented papillary adenocarcinoma. Histological results were benign in all other cases.
  
  
  CONCLUSIONS
  Thyroid surgery in children and adolescents is part of global multidisciplinary management of thyroid disorders in children. Recurrent laryngeal nerve paralysis is a rare complication, but may occur despite the use of intraoperative recurrent laryngeal nerve monitoring. Permanent hypoparathyroidism is the most common complication and is correlated with immediate postoperative serum calcium. Systematic prophylactic total thyroidectomy in patients with a RET proto-oncogene mutation allowed early diagnosis of MTC in one-third of cases. In view of the low rate of malignant nodules in our series, the malignant thyroid nodule rates reported in children in the literature may be overestimated.
authors.affiliation: Service d'ORL et Chirurgie Cervico Faciale, CHU de Montpellier, Université Montpellier 1, Hôpital Gui-de-Chauliac, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France. Electronic address: mohamed.akkari.orl@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Akkari
authors.affiliation: Service d'ORL et Chirurgie Cervico Faciale, CHU de Montpellier, Université Montpellier 1, Hôpital Gui-de-Chauliac, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
authors.forename: M
authors.initials: M
authors.lastname: Makeieff
authors.affiliation: Service d'Endocrinologie Pédiatrique, CHU de Montpellier, Université Montpellier 1, Hôpital Gui-de-Chauliac, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
authors.forename: C
authors.initials: C
authors.lastname: Jeandel
authors.affiliation: Service des maladies endocriniennes, CHU de Montpellier, Université Montpellier 1, Hôpital Gui-de-Chauliac, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
authors.forename: I
authors.initials: I
authors.lastname: Raingeard
authors.affiliation: Service d'ORL et Chirurgie Cervico Faciale, CHU de Montpellier, Université Montpellier 1, Hôpital Gui-de-Chauliac, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
authors.forename: C
authors.initials: C
authors.lastname: Cartier
authors.affiliation: Service d'ORL et Chirurgie Cervico Faciale, CHU de Montpellier, Université Montpellier 1, Hôpital Gui-de-Chauliac, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
authors.forename: R
authors.initials: R
authors.lastname: Garrel
authors.affiliation: Service d'ORL et Chirurgie Cervico Faciale, CHU de Montpellier, Université Montpellier 1, Hôpital Gui-de-Chauliac, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
authors.forename: B
authors.initials: B
authors.lastname: Guerrier
authors.affiliation: Service d'ORL et Chirurgie Cervico Faciale, CHU de Montpellier, Université Montpellier 1, Hôpital Gui-de-Chauliac, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
authors.forename: C
authors.initials: C
authors.lastname: Blanchet
authors.affiliation: Service d'ORL et Chirurgie Cervico Faciale, CHU de Montpellier, Université Montpellier 1, Hôpital Gui-de-Chauliac, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
authors.forename: M
authors.initials: M
authors.lastname: Mondain
mesh_terms: D000231:Adenocarcinoma, Papillary / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D018276:Carcinoma, Medullary / Q000473:pathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003062:Codon; D005091:Exons; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000209:etiology*; D007223:Infant; D008297:Male; D016343:Monitoring, Intraoperative; D009154:Mutation; D000090063:Proto-Oncogene Mas; D012009:Recurrent Laryngeal Nerve / Q000002:abnormalities; D012189:Retrospective Studies; D013959:Thyroid Diseases / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects*; D014826:Vocal Cord Paralysis / Q000209:etiology*
chemical_list: D003062:Codon; C000715470:MAS1 protein, human; D000090063:Proto-Oncogene Mas
keywords: Child; Differentiated thyroid cancer; Goitre; Hypoparathyroidism; Lobectomy with isthmusectomy; Medullary thyroid cancer; Recurrent laryngeal nerve paralysis; Thyroidectomy