Thyroid surgery in children and young adults: potential overtreatment and complications.
PURPOSE
Thyroid nodules in the pediatric population are more frequently associated with malignant thyroid disease than in adult cohorts. Yet, there is a potential risk of surgical overtreatment. With this single center study, an analysis of potential overtreatment for suspected malignant thyroid disease in children and young adults was aimed for.


METHODS
In a period from 2005 to 2018, 155 thyroid operations in children and young adults performed at the University Medical Center Mainz, Germany, were analyzed (patient age 3-20 years, 117 female). Cases were categorized for preoperative diagnosis: non-malignant (group I, n = 45) and malignant thyroid disease (group II, n = 110). Postoperative parameters (histology, complication rates) were assessed and compared between groups.


RESULTS
91.1% of group I were histologically benign. 44.5% of group II harbored malignancy. Permanent hypoparathyroidism was documented in group I (2.7%) and in group II (1.4%, p = 1.000). Wound infections were absent in group I but observed in group II (0.9%, p = 1.000). Transient vocal cord palsy was recorded only in group I (2.3%, 2/85 vs. 0/177 nerves at risk, p = 0.104). Permanent vocal cord palsies were absent.


CONCLUSION
Preoperative diagnoses were correct in over 90% of group I and in nearly 45% of group II. The high proportion of carcinomas in group II ruled out the issue of potential overtreatment. The risk of severe postoperative complications was equally low in both patient groups.
['Staubitz|Julia I|JI|', 'Bode|Julia|J|', 'Poplawski|Alicia|A|', 'Watzka|Felix|F|', 'Pohlenz|Joachim|J|', 'Lang|Hauke|H|', 'Musholt|Thomas J|TJ|http://orcid.org/0000-0002-4498-7439']
D000293:Adolescent D002648:Child D002675:Child, Preschool D015331:Cohort Studies D005260:Female D006801:Humans D008297:Male D000069342:Medical Overuse D018579:Patient Selection D011183:Postoperative Complications D000078337:Procedures and Techniques Utilization D013964:Thyroid Neoplasms D016606:Thyroid Nodule D013965:Thyroidectomy D055815:Young Adult
Endocrine Papillary thyroid carcinoma follicular thyroid carcinoma Pediatric thyroid surgery