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Thyroid surgery in children and teenager: a necessary implication of the pediatric surgeons: report of 45 interventions

L. Coupris*, R. Coutant**, N. Bouhours**, F. Gatelais**, S. Rouleau**, E. Eyssartier*, D. Geslin*, D. Weil*

* Department of Visceral Pediatric Surgery,Pediatric Unit, CHU Angers

** Department of Pediatric Endocrinology, Pediatric Unit, CHU Angers, France

 

ABSTRACT

Introduction: The pediatric thyroid surgery is mentioned little in our meetings. This testifies a certain rarity but also little involvement by the pediatric surgeons. It is more frequently indicated in teenagers and the patients are guided to our adult endocrine surgery colleagues. However the indications in young children (especially prevention of the familial medullary cancer) must be a reflection subject for our pediatric surgical teams.

Material and methods: 44 patients (16 boys and 28 girls) coming from the same unit of pediatric endocrinology will have 45 interventions (from 1984 to 2009). Operated between 28 and 189 months of age, by the same surgeon, 50% had less than 10 years of age. Apart from the preventive surgery, the type of excision (lobectomy or total thyroidectomy) for more heterogeneous indications was generally established by the extemporaneous examination.

Results: We performed 11 lobotomies (6 vesicular adenomas, 2 multinodular goiters, 1 functional hyperplasia, 1 hemangioma and 1 teratoma), 32 total thyroidectomies (10 papillary cancers including 6 metastatic, 17 “preventive surgery” for family medullary cancer, 3 multinodular goiters, 2 hyperthyroidisms) and 2 excision of ectopic thyroid. We observed in one case a post-operative compressive hematoma requiring emergency reintervention, two recurrent paralyses, one consented, the other séquellary but no final hypoparathyroidism. In case of cancer, a second look was indicated in 3 cases.

Discussion and conclusion: Being in contact with a reference centre of pediatric endocrinology, it is possible to us to develop a regular activity of pediatric thyroid surgery. Our intention is to sensitize the pediatric surgeons to invest themselves because there are now surgical indications in young children who belong to our specific environment.

 

Key words: thyroid, surgery, child