Endocrine Abstracts

JOINT218210

Aim: To study the structure of thyroid diseases in children who required surgical treatment, analysis of their gender and age distribution, features of the preoperative, intra- and postoperative course in case of thyroid nodules (TN) and diffuse toxic goiter (DTG), to determine the frequency of early and late complications, disease recurrences and their further treatment.

Materials and methods: This retrospective cohort study included 456 children (under 18 years of age) who underwent thyroidectomy at the Center between 2013-2022. According to the results of clinical and laboratory data and final pathohistological examination, all patients were divided into 3 groups: thyroid cancer (n = 241), TN (n = 151) and DTG (n = 64). In the preoperative period, the duration of the disease, patients’ age, sex distribution, thyroid function, the results of instrumental examinations (thyroid ultrasound, FNAB with cytological assessment according to Bethesda) were investigated in patients with TN and DTG. In patients available for further postoperative follow up, the postoperative thyroid function, frequency of early and late complications and further treatment were studied.

Results: Among all thyroid diseases that required surgical intervention, thyroid cancer (52.8%) and female gender (75%) prevailed. The mean age of the operated children was 14.4±2.5 years. TN were significantly more frequent in pubertal age group (P <0.05). The mean duration of the disease before surgery in case of TN was shorter than in DTG (P <0.001). Thyroidectomy was most often done in DTG, and hemithyroidectomy (HT) and/or HT+ lymphadenectomy (LD) in case of TN. In 21.3% of patients with TN after HT/HT+LD, euthyroidism was achieved. In patients with DTG in the late postoperative period, persistent hypoparathyroidism was the only and most frequent complication (n = 2, 12.5%). In contrast, in TN in the late postoperative period, 7 patients (10%) were diagnosed with a relapse of the disease, which occurred more often in younger children (13.0 [13.0; 14.0] years) compared to the group without relapse ( P = 0.01). Treatment of relapse included follow-up in the majority of patients with TN (71.4%).

Conclusions: Thyroid cancer predominated in the structure of thyroid diseases requiring surgical intervention. Persistent hypoparathyroidism was the only complication in the treatment of patients with DTG. Considering the preservation of euthyroidism in 21.3% of patients with TN after HT/HT+LD, broader use of organ-preserving surgery should be considered, with further evaluation of postoperative hormone replacement therapy.