Management of benign paediatric thyroid nodules: experience from paediatric ENT services of a tertiary care hospital
Keywords:Thyroid nodule, Children, Paediatric thyroidectomy, Total-thyroidectomy
Thyroid nodules are a common occurrence in adults but are rarely seen in children. We present here four cases of paediatric thyroid nodules. Patients were subjected to a thorough clinical evaluation, blood thyroid level testing, ultrasonography (USG) and fine needle aspiration cytology (FNAC). The size of the nodules ranged from 2 cm to 7.5 cm. All four nodules were reported as “benign” on FNAC, of which three under-went total thyroidectomy owing to the bi-laterality and large size of the nodules. None of the cases had post-operative complications of hypocalcemia or recurrent laryngeal nerve paralysis. Of the 3 patients taken up for surgery one patient was found to have papillary thyroid carcinoma. Subsequent radiological investigation showed no residual disease. All three operated cases were followed-up in the ENT outpatient department for at least 2 years and showed no signs of recurrence. One patient with a small thyroid nodule (2 cm) was managed non – surgically and has been kept on follow up since 12 months. In our experience, total thyroidectomy, even in a benign disease, in expert hands, is a safe procedure and the best management option in children with large goiter, to avoid recurrence and thereby a redo surgery.
Burch HB. Evaluation and management of the solid thyroid nodule. Endocrino Metabol Clinics North Am. 1995;24(4):663-710.
Francis GL, Waguespack SG, Bauer AJ, Angelos P, Benvenga S, Cerutti JM, et al. Management guidelines for children with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on pediatric thyroid cancer. Thyroid. 2015;25(7):716-59.
Hogan AR, Zhuge Y, Perez EA, Koniaris LG, Lew JI, Sola JE. Pediatric thyroid carcinoma: incidence and outcomes in 1753 patients. J Surgic Res. 2009;156(1):167-72.
Niedziela M. Pathogenesis, diagnosis and management of thyroid nodules in children. Endoc Canc. 2006;13(2):427-53.
Mussa A, De Andrea M, Motta M, et al. Predictors of Malignancy in Children with Thyroid Nodules. J Pediatr. 2015;167:886‒92.
Hung W. Solitary thyroid nodules in 93 children and adolescents: A 35-years experience. Horm Res. 1999;52:15-8.
Raval MV, Browne M, Chin AC, Zimmerman D, Angelos P, Reynolds M. Total thyroidectomy for benign disease in the pediatric patient—feasible and safe. J Pediat Surg. 2009;44(8):1529-33.
Barczynski M, Konturek A, Stopa M, Cichon S, Richter P, Nowak W. Total thyroidectomy for benign thyroid disease: is it really worthwhile?. Ann Surg. 2011;254(5):724-30.
Sosa JA, Bowman HM, Tielsch JM, Powe NR, Gordon TA, Udelsman R. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg. 1998;228(3):320.