title: Management of Childhood Thyroid Nodules: Surgical and Endocrinological Findings in a Large Group of Cases.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Ege University Faculty of Medicine, Department of Pediatric Surgery, İzmir, Turkey.
authors.forename: Emre
authors.initials: E
authors.lastname: Divarcı
authors.forename: Ülgen
authors.initials: Ü
authors.lastname: Çeltik
authors.forename: Zafer
authors.initials: Z
authors.lastname: Dökümcü
authors.forename: Orkan
authors.initials: O
authors.lastname: Ergün
authors.forename: Geylani
authors.initials: G
authors.lastname: Özok
authors.forename: Samim
authors.initials: S
authors.lastname: Özen
authors.forename: Damla Gökşen
authors.initials: DG
authors.lastname: Şimşek
authors.forename: Şükran
authors.initials: Ş
authors.lastname: Darcan
authors.forename: Nazan
authors.initials: N
authors.lastname: Çetingül
authors.forename: Aylin
authors.initials: A
authors.lastname: Oral
authors.forename: Yeşim
authors.initials: Y
authors.lastname: Ertan
authors.forename: Bengü
authors.initials: B
authors.lastname: Demirağ
authors.forename: Ahmet
authors.initials: A
authors.lastname: Çelik
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016606:Thyroid Nodule / Q000175:diagnosis* / Q000628:therapy*
keywords: Thyroid nodule; frozen section fine-needle aspiration biopsy.; papillary carcinoma; thyroidectomy