Surgical treatment of differentiated thyroid carcinoma in children.

INTRODUCTION: A retrospective clinical study was carried out to define the appropriate definitive operation for treating differentiated thyroid carcinoma (DTC) in children.

METHODS: During a 24-year period between 1974 and 1997, 18 children younger than 16 years at presentation were histopathologically proven to have DTC in Hacettepe University Children's Hospital, Department of Pediatric Surgery. The clinical characteristics on admission, operative findings, procedures, operative complications, and follow-up results according to definitive operations were compared to find out the appropriate procedure.

RESULTS: There were 15 female (83.3%) and 3 male (16.7%) patients yielding a female/male ratio of 5 and the average age being 11.6+/-2.1 years. The definitive operations were near total thyroidectomy, total thyroidectomy, near total thyroidectomy plus excision of the only palpable lymph nodes (EPLN), total thyroidectomy plus EPLN and total thyroidectomy plus modified radical neck dissection (MRND) in 3 (16.7%), 3 (16.7%), 1 (5.5%), 9 (50%), and 2 (11.1 %) patients respectively. Among the patients having undergone near total thyroidectomy, one had recurrences both in the thyroid bed and the cervical lymph nodes. In a patient undergoing almost total thyroidectomy and EPLN, recurrences involving thyroid bed, cervical lymph nodes and lungs were encountered. In 9 patients undergoing total thyroidectomy and EPLN 4 had cervical lymph node recurrences. Complications have included permanent hypoparathyroidism following total thyroidectomy and MRND. Additionally, operations for recurrences resulted in unilateral permanent recurrent laryngeal nerve palsies in two patients.

CONCLUSIONS: Total thyroidectomy with evaluation of central compartment, entire jugular chain and region of lower spinal accessory nerve and removal of all identifiable lymph nodes seems to be the most appropriate surgical treatment for DTC encountered in children.