10 years of experience in providing surgical care to children with nodular and diffuse toxic goiter

Objective — to study the structure of thyroid diseases in children who required surgical treatment, analyze their gender and age distribution, and assess preoperative, intraoperative, and postoperative courses for thyroid nodules (TN) and diffuse toxic goiter (DTG). The study also aimed to evaluate the frequency of early and late complications, disease recurrences, and further treatment approaches. 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 with TN and DTG, 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 acheived. 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 among thyroid diseases requiring surgical intervention. Persistent hypoparathyroidism was the only late complication in DTG cases. Considering the preservation of euthyroidism in 21.3% of patients with TN after HT/HT+LD, broader use of organ‑preserving surgeries should be considered, with further evaluation of postoperative hormone replacement therapy.