Endocrine Abstracts

JOINT3715

Introduction: Thyroid nodules are rare in the pediatric population, with a predominance in females. Benign thyroid nodules and Graves’ disease are the most common surgical indications. Surgical management can be challenging in children. This study explores indications, surgical techniques, and outcomes of thyroid surgery in children. Matériel et méthodes: This is a retrospective study conducted in the ENT department at Fattouma Bourguiba Hospital in Monastir over a four-year period, from January 2021 to December 2024., involving 16 cases that underwent thyroid surgery. Résultats: Our series includes 16 cases that underwent thyroid surgery. Among these patients, 15 cases were operated on for thyroid nodules, and one patient underwent surgery for Graves’ disease resistant to medical treatment. The average age was 16.61 years, with extremes ranging from 13 to 17 years, and the sex ratio was 0.05 (1 male/17 females). Regarding medical history, one child was followed for Graves’ disease, one for congenital hypothyroidism, and two cases had adrenal insufficiency. These children presented with anterior low cervical swellings without signs of compression. On examination, an anterior low cervical swelling, mobile on swallowing was found in all cases, measuring 3 to 5 cm, along with firm, mobile, painless cervical lymphadenopathies of 2 cm in one patient. Ultrasound findings showed an EUTIRADS 2 nodule in two cases (32–40 mm), EUTIRADS 3 in 11 cases (26–40 mm), EUTIRADS 4 in four cases (17–42 mm), EUTIRADS 5 in two cases (26 and 27 mm), and one case of a hypervascularized goiter suggestive of Graves’ disease. Fine needle aspiration of a lymphadenopathy was performed in one patient, which was suggestive of metastasis from a papillary carcinoma. A lobectomy was performed in nine cases, total thyroidectomy in seven cases, mediastinal-recurrent lymph node dissection in two cases, and functional neck dissection in one patient. Postoperative outcomes were uneventful in all cases, with only one case of postoperative hypocalcemia, which was corrected with calcium supplementation. Histopathological examination revealed a benign nodule in 13 cases, a follicular carcinoma in one case, and a papillary carcinoma in two cases, which were referred to nuclear medicine for radioactive iodine treatment.

Conclusion: Pediatric thyroid pathologies requiring surgery are much rarer than in adults. Thyroid nodules in children should be evaluated with ultrasound and fine-needle aspiration cytology to assess the risk of malignancy. This approach will ensure appropriate surgical management.