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 carcin oma (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 Surger y. The clinical characteristics on admission, operative findings, procedure s, operative complications, and follow-up results according to definitive o perations 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 de finitive operations were near total thyroidectomy, total thyroidectomy, nea r total thyroidectomy plus excision of the only palpable lymph nodes (EPLN) , total thyroidectomy plus EPLN and total thyroidectomy plus modified radic al 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 to tal thyroidectomy, one had recurrences both in the thyroid bed and the cerv ical lymph nodes. In a patient undergoing almost total thyroidectomy and EP LN, recurrences involving thyroid bed, cervical lymph nodes and lungs were encountered. In 9 patients undergoing total thyroidectomy and EPLN 4 had ce rvical lymph node recurrences. Complications have included permanent hypopa rathyroidism following total thyroidectomy and MRND. Additionally, operatio ns for recurrences resulted in unilateral permanent recurrent laryngeal ner ve palsies in two patients. Conclusions: Total thyroidectomy with evaluation of central compartment, en tire jugular chain and region of lower spinal accessory nerve and removal o f all identifiable lymph nodes seems to be the most appropriate surgical tr eatment for DTC encountered in children.