Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 144 No. 0910 (2014)

Paediatric thyroid surgery is safe – experiences at a tertiary surgical centre

  • René Fahrner
  • Lucia Übersax
  • Anja Mettler
  • Steffen Berger
  • Christian A. Seiler
Cite this as:
Swiss Med Wkly. 2014;144:w13939


PRINCIPLES: Thyroidectomy in children is rare and mostly performed because of thyroid neoplasms. The aim of this study based on prospective data acquisition was to evaluate whether thyroid surgery in children can be performed as safely as in adults when undertaken by a team of adult endocrine surgeons and paediatric surgeons.

METHODS: Between 2002 and 2012, 36 patients younger than 18 years underwent surgery for thyroid gland pathologies. All surgical procedures were performed by an experienced endocrine surgeon and a paediatric surgeon. Baseline demographic data, surgical procedure, duration of operation, length of hospital stay, and postoperative morbidity and mortality were analysed.

RESULTS: The median age of all patients was 13 years (range 2–17 years), with predominantly female gender (n = 30, 83%). The majority of operations were performed because of benign thyroid disease (n = 27, 75%) and only a minority because of malignancy or genetic abnormality with predisposition for malignant transformation (MEN) (n = 9, 25%). Total thyroidectomy was performed in the majority of the patients (n = 24, 67%). The median duration of the surgical procedure was 153 minutes (range 90–310 minutes). The median hospital stay was 5 days (3‒11 days). One patient developed persistent hypoparathyroidism after neck dissection due to cancer. One persistent and two temporary recurrent nerve palsies occurred.

CONCLUSION: This study demonstrated that paediatric thyroidectomy is safe as performed by this team of endocrine and paediatric surgeons, with acceptable morbidity even when total thyroidectomy was performed in the case of benign disease.


  1. Reeve TS, Delbridge L, Cohen A, Crummer P. Total thyroidectomy. The preferred option for multinodular goiter. Ann Surg. 1987;206:782–6.
  2. Muller PE, Kabus S, Robens E, Spelsberg F. Indications, risks, and acceptance of total thyroidectomy for multinodular benign goiter. Surg today. 2001;31:958–62.
  3. 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;254:724–29; discussion 9–30.
  4. Burke JF, Sippel RS, Chen H. Evolution of pediatric thyroid surgery at a tertiary medical center. J Surg Res. 2012;177:268–74.
  5. Scholz S, Smith JR, Chaignaud B, Shamberger RC, Huang SA. Thyroid surgery at Children's Hospital Boston: a 35–year single-institution experience. J Pediatr Surg. 2011;46:437–42.
  6. 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 Pediatr Surg. 2009;44:1529–33.
  7. Kurmann A, Martens F, Inglin R, Schmid SW, Candinas D, Seiler CA. Impact of surgical technique on operative morbidity and its socioeconomic benefit in thyroid surgery. Langenbecks Arch Surg. 2012. Epub 2012/07/19.
  8. Ho TW, Shaheen AA, Dixon E, Harvey A. Utilization of thyroidectomy for benign disease in the United States: a 15–year population-based study. J Am Surg. 2011;201:570–4.
  9. Peroni E, Angiolini MR, Vigone MC, Mari G, Chiumello G, Beretta E, et al. Surgical management of pediatric Graves‘ disease: an effective definitive treatment. Pediatr Surg Int. 2012;28:609–14.
  10. Bargren AE, Meyer-Rochow GY, Delbridge LW, Sidhu SB, Chen H. Outcomes of surgically managed pediatric thyroid cancer. J Surg Res. 2009;156:70–3.
  11. Wilhelm SM, McHenry CR. Total thyroidectomy is superior to subtotal thyroidectomy for management of Graves' disease in the United States. World J Surg. 2010;34:1261–4.
  12. Tuggle CT, Roman SA, Wang TS, Boudourakis L, Thomas DC, Udelsman R, et al. Pediatric endocrine surgery: who is operating on our children? Surgery. 2008;144:869–77; discussion 77.
  13. Wood JH, Partrick DA, Barham HP, Bensard DD, Travers SH, Travers SH, et al. Pediatric thyroidectomy: a collaborative surgical approach. J Pediatr Surg. 2011;46:823–8.
  14. Carpi A, Rossi G, Romani R, Di Coscio G, Nicolini A, Simoncini T, et al. Are risk factors common to thyroid cancer and nodule? A forty years observational time-trend study. PloS one. 2012;7:e47758.
  15. Thomusch O, Sekulla C, Ukkat J, Gastinger L, Lippert H, Dralle H. Quality assurance study of benign and malignant goiter. Prospective multicenter data collection regarding 7,617 patients. Zentralbl Chir. 2001;126:664–71.
  16. Poorten VV, Hens G, Delaere P. Thyroid cancer in children and adolescents. Curr Opin Otolaryngol Head Neck Surg. 2013;21:135–42.
  17. Kumar A, Bal CS. Differentiated thyroid cancer. J Indian Pediatr. 2003;70:707–13.
  18. Sosa JA, Tuggle CT, Wang TS, Thomas DC, Boudourakis L, Rivkees S, et al. Clinical and economic outcomes of thyroid and parathyroid surgery in children. J Clin Endocrinol Metab. 2008;93:3058–65.
  19. Morris LF, Waguespack SG, Warneke CL, Ryu H, Ying AK, Anderson BJ, et al. Long-term follow-up data may help manage patient and parent expectations for pediatric patients undergoing thyroidectomy. Surgery. 2012;152:1165–71.
  20. Barczyński M, Konturek A, Hubalewska-Dydejczyk A, Gołkowski F, Nowak W. Randomized clinical trial of bilateral subtotal thyroidectomy versus total thyroidectomy for Graves' disease with a 5–year follow-up. Br J Surg. 2012;99:515–22.
  21. Witte J, Goretzki PE, Dotzenrath C, Simon D, Felis P, Neubauer M, et al. Surgery for Graves‘ disease: total versus subttal thyroidectomy-results of a prospective randomized trial. World J Surg. 2000;24:1303–11.
  22. Järhult J, Rudberg C, Larsson E, Selvander H, Sjövall K, Winsa B, et al. Graves' disease with moderate-severe endocrine ophthalmopathy-long term results of a prospective, randomized study of total or subtotal thyroid resection. Thyroid. 2005;15:1157–64.
  23. Breuer CK, Solomon D, Donovan P, Rivkees SA, Udelsman R. Effect of patient Age on surgical outcomes for Graves' disease: a case-control study of 100 consecutive patients at a high volume thyroid surgical center. Int J Pediatr Endocrinol. 2013;2013:1.
  24. Sadowski SM, Soardo P, Leuchter I, Robert JH, Triponez F. Systematic use of recurrent laryngeal nerve neuromonitoring changes the operative strategy in planned bilateral thyroidectomy. Thyroid. 2013;23:329–33.
  25. Prokopakis E, Kaprana A, Velegrakis S, Panagiotaki I, Chatzakis N, Iro H, et al. Intraoperative recurrent laryngeal nerve monitoring in revision thyroidectomy. Eur Arch Otorhinolaryngol. 2013;270(9):2521–4.
  26. Sitges-Serra A, Fontané J, Dueñas JP, Duque CS, Lorente L, Trillo L, et al. Prospective study on loss of signal on the first side during neuromonitoring of the recurrent laryngeal nerve in total thyroidectomy. Br J Surg. 2013;100:662–6.
  27. Schneider R, Bures C, Lorenz K, Dralle H, Freissmuth M, Hermann M. Evolution of nerve injury with unexpected EMG signal recovery in thyroid surgery using continuous intraoperative neuromonitoring. World J Surg. 2013;37:364–8.
  28. Yunker WK, Hassan SF, Ferrell LB, Hicks MJ, Giannoni CM, Wesson DE, et al. Needle core biopsy in the diagnosis of pediatric thyroid neoplasms: a single institution retrospective review. Pediatr Surg Int. 2013;29:437–43.
  29. Bas VN, Aycan Z, Cetinkaya S, Uner C, Cavusoglu HY, Arda N. Thyroid nodules in children and adolescents: a single institution’s experience. J Pediatr Endocr Met 2012;25:633–8.
  30. Peli M, Capalbo E, Lovisatti M, Cosentino M, Berti E, Mattai Dal Moro R, et al. Ultrasound guided fine-needle aspiration biopsy of thyroid nodules: guidelines and recommendations vs clinical practice; a 12–month study of 89 patients. J Ultrasound. 2012;15:102–7.
  31. Coorough N, Hudak K, Jaume JC, Buehler D, Selvaggi S, Rivas J, et al. Nondiagnostic fine-needle aspirations of the thyroid: is the risk of malignancy higher? J Surg Res. 2013 [Epub ahead of print].
  32. Roy R, Kouniavsky G, Schneider E, Allendorf JD, Chabot JA, Logerfo P, et al. Predictive factors of malignancy in pediatric thyroid nodules. Surgery. 2011;150(6):1228–33.
  33. Corrias A, Mussa A. Thyroid nodules in pediatrics: which ones can be left alone, which ones must be investigated, when and how. J Clin Res Pediatr Endocrinol. 2013;5(Suppl 1):57–69.
  34. Baglaj M, Gerus S, Dorobisz U, Lukienczuk T, Wikiera B. Thyroidectomy in children: changing trends and surgical strategies. Adv Clin Exp Med. 2013;22:387–393.
  35. Kurmann A, Herden U, Schmid SW, Candinas D, Seiler CA. Morbidity rate of reoperation in thyroid surgery: a different point of view. Swiss Med Wkly. 2012;142:w13643.
  36. Fahrner R, Turina M, Neuhaus V, Schöb O. Laparoscopic cholecystectomy as a teaching operation: comparison of outcome between residents and attending surgeons in 1,747 patients. Langenbecks Arch Surg. 2012;397:103–10.
  37. Dotzenrath CM, Cupisti K, Raffel A, Aust B, Yang Q, Krüger B, et al. Do germans keep patients too long in hospital? A prospective randomized trial. World J Surg. 2005;29:1189–93.
  38. Trocchi P, Kluttig A, Dralle H, Sekulla C, Biermann M, Stang A. Thyroid cancer surgery in Germany: an analysis of the nationwide DRG statistics 2005–2006. Langenbecks Arch Surg. 2012;397:421–8.
  39. Wilson BE, Cheney L, Patel B, Holland AJ. Appendicectomy at a children’s hospital: what has changed over a decade? ANZ J Surg. 2012;82:639–43.
  40. Jen HC, Shew SB. Hospital differences in short-term outcomes for uncomplicated pediatric patients with gallbladder disease. J Surg Res. 2009;153:195–200.
  41. Wang TS, Roman SA, Sosa JA. Predictors of outcomes following pediatric thyroid and parathyroid surgery. Curr Opin Oncol. 2009;21:23–8.
  42. Breuer C, Tuggle C, Solomon D, Sosa JA. Pediatric thyroid disease: when is surgery necessary, and who should be operating on our children. J Clin Res Pediatr Endocrinol. 2013;5(Suppl 1):79–85.

Most read articles by the same author(s)