Aim: Thyroid surgery in children is infrequently undertaken, but due to genetic screening of families with multiple endocrine neoplasia (MEN) syndromes, more paediatric thyroidectomies are being performed. In this study we explored the indications for thyroidectomy and the post operative course and consequences of surgery carried out in our unit.
Methods: Retrospective review of medical case notes of children who had either total or partial thyroidectomies between 1995 and 2007.
Results: Over the 12 year period, 23 children underwent thyroidectomy. Medical notes of 22 patients (14 girls) were reviewed. Information was unavailable on one patient. The age of the patients ranged from 1 to 14 years. In 14 (64%) children, a total thyroidectomy was done and in 8 (36%) subtotal or lobectomy was performed. The indication for thyroidectomy in 11 (50%) cases was prophylaxis for MEN type 2, 5 (23%) were carried out for suspected carcinoma, 2 (9%) for refractory Graves disease and 4 (18%) for other causes. Duration of hospital stay varied from 1 to 14 (median 3) nights, and no child needed to be admitted to the paediatric intensive care unit. Fourteen children (64%) did not have any immediate complications, 8 (36%) had hypocalcaemia (calcium level <2.0 mmol/l) and 1 (4.5%) had voice disturbance. Longer term complications occurred in 5 (22.7%) cases. Of these, 3 (13.6%) had hypoparathyroidism, 1 (4.5%) had voice disturbance and 1 (4.5%) developed a hypertrophic scar. As expected, all children who had a total thyroidectomy received thyroxine replacement.
Conclusion: It is suggested that complications in children after thyroid surgery are higher than in adults. Although our numbers are small, and there was a high incidence of early hypocalcaemia, it is reassuring that permanent hypoparathyroidism is rare. As prophylactic thyroidectomies in children are on the increase, we recommend that careful planning and management by an experienced multidisciplinary team are essential to ensure minimal complications.