Surgical Management of Pediatric Patients with Thyroid Disorders and Assessment of Complication Rates Associated with 43 Cases: A Single-Center Experience

Yıl 2020, Cilt: 11 Sayı: 41, 113 - 117, 01.12.2020

Ozgur Caglar Erdem Karadeniz Müfide Akcay Kamber Kasalı

https://doi.org/10.17944/mkutfd.810281

Öz

Objective: In this study, we aimed to investigate complication rates and associated factors in pediatric patients who had undergone thyroid surgery.
Material and Methods: The charts of patients aged under 19 years who had undergone thyroid surgery between 2010 and 2019 were retrospectively investigated. Demographic data, thyroid function test results, ultrasonographic findings, the blood calcium level, status of lymph node metastasis, the type of surgery performed, results of the pathology report, and complications were recorded. The IBM SPSS 20 statistical software performed the statistical analysis. P<0.05 was considered statistically significant.
Results: Of 43 patients involved in the study, 5 (11.6%) were male, and 38 (88.4%) were female. The mean age was 16.7 (10-19) years. The surgical indications were the presence or suspicion of malignancy in 25 patients, compression or a cosmetic cause in 8 patients, toxic nodular goiter in 8 patients, and Basedow-Graves’ Disease in 2 patients. Ten patients were hyperthyroid, and 33 patients were euthyroid preoperatively.
Lobectomy was performed in 19 patients, whereas total thyroidectomy was performed in 24 patients. I9 patients were found to undergo central lymph node dissection due to central lymph node metastasis.
Histopathological examination revealed a malignancy (papillary carcinoma) in 16 (37.2%) patients, and a benign condition in 27 (62.8%) patients. In the postoperative period, hypocalcemia lasting no longer than 6 months developed in 11 (25.5%) patients. No difference was determined between the group encountering hypocalcemia and the group without hypocalcemia regarding gender, age, preoperative Ca+ (calcium) value, and the iatrogenic parathyroidectomy rate (p> 0.05). The incidence of hypocalcemia was higher in the patient group who had undergone total thyroidectomy than the group with lobectomy (p<0.05). The development rate of hypocalcemia was higher in the patient group who had undergone central dissection when compared to those with no central dissection (p<0.05).
Conclusion: In pediatric patients who undergo total thyroidectomy and central dissection, performing the dissection more gently and meticulously will reduce the complication risk regarding postoperative hypocalcemia.

Anahtar Kelimeler

Adolescent thyroidectomy, hypocalcemia, iatrogenic parathyroidectomy

Pediatrik Tiroid Hastalarının Cerrahi Yönetimi ve Komplikasyon Oranlarının 43 Olgu Eşliğinde Değerlendirilmesi: Tek Merkez Deneyimi

Öz

Amaç: Bu çalışmada tiroid cerrahisi geçiren çocuk hastalardaki komplikasyon oranlarımızı ve bununla ilişkili olabilecek faktörleri araştırmayı amaçladık.
Gereç ve Yöntem: 2010 ile 2019 yılları arasında tiroid cerrahisi yapılan 19 yaşın altındaki hasta dosyaları geriye dönük incelendi. Hastaların demografik verileri, tiroid fonksiyon test sonuçları, ultrasonografi bulguları, kalsiyum değeri, lenf nodu metastazı durumu, yapılan ameliyat şekli, patoloji sonucu ve komplikasyonlar kaydedildi. Analizler IBM SPSS 20 istatistik analiz programı ile yapıldı. İstatistiksel anlamlılık düzeyi p<0,05 olarak alındı.
Bulgular: Çalışmadaki 43 hastanın 5’i (%11,6) erkek, 38’i (%88,4) kadın idi. Yaş ortalaması 16,7 (10-19) yıl idi. Ameliyat endikasyonları 25 hastada malignite veya malignite kuşkusu idi, 8 hastada bası veya kozmetik nedenler, 8 hastada toksik nodüler guatr, 2 hastada Basedow Graves idi. Ameliyat öncesi 10 hastada hipertiroidi, 33 hastada ise ötiroidi mevcuttu.
19 hastaya lobektomi, 24 hastaya total tiroidektomi yapıldı. 9 hastaya santral lenf nodu metastazı nedeniyle santral lenf nodu diseksiyonu yapıldı.
Histopatolojik incelemede 16 (%37,2) hasta malign (Papiller karsinom), 27 (%62,8) hasta benign olarak rapor edildi. Ameliyat sonrası 11 (%25,5) hastada 6 aydan uzun sürmeyen hipokalsemi gelişti. Hipokalsemi gelişen grup ile hipokalsemi gelişmeyen grup arasında cinsiyet, yaş, ameliyat öncesi Ca+ (kalsiyum) değeri ve iyatrojenik paratiroidektomi arasında herhangi bir ilişki saptanmadı (p>0,05). Total tiroidektomi yapılan hasta grubunda hipokalsemi görülme oranı lobektomi yapılan gruptan daha yüksekti (p<0,05). Santral diseksiyon yapılan grupta hipokalsemi gelişme oranı santral diseksiyon yapılmayan gruba göre daha yüksekti (p<0,05).
Sonuç: Çocuklarda, total tiroidektomi ve santral diseksiyon yapılan hastalarda postoperatif hipokalsemi için diseksiyon sırasında daha nazik ve dikkatli olunması komplikasyon riskini azaltacaktır.

Anahtar Kelimeler

hipokalsemi, Adolesan tiroidektomi, iyatrojenik paratiroidektomi

Kaynakça

• Referans 1. 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. Thyroid. 2015;25(7):716-59. doi: 10.1089/thy.2014.0460.
• Referans 2. 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(Suppl 1):79-85. DOI: 10.4274/jcrpe.817
• Referans 3. 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(8):3058-65. DOI: 10.1210/jc.2008-0660
• Referans 4. Al-Qurayshi Z, Hauch A, Srivastav S, Aslam R, Friedlander P, Kandil E. A National Perspective of the Risk, Presentation, and Outcomes of Pediatric Thyroid Cancer. JAMA Otolaryngol Head Neck Surg. 2016;142(5):472-8. DOI: 10.1001/jamaoto.2016.0104
• Referans 5. Youngwirth LM, Adam MA, Thomas SM, Roman SA, Sosa JA, Scheri RP. Pediatric thyroid cancer patients referred to high-volume facilities have improved short-term outcomes. Surgery. 2018;163(2):361-6. DOI: 10.1016/j.surg.2017.09.042
• Referans 6. Tracy ET, Roman SA. Current management of pediatric thyroid disease and differentiated thyroid cancer. Curr Opin Oncol. 2016;28(1):37-42. DOI: 10.1097/CCO.0000000000000250
• Referans 7. Önder A, Aycan Z. Approach to thyroid nodules in children and adolescents. Turk J Pediatr. 2014;56(3):219-25. PMID: 25341591
• Referans 8. Park S, Jeong JS, Ryu HR, Lee CR, Park JH, Kang SW, et al. Differentiated thyroid carcinoma of children and adolescents: 27-year experience in the yonsei university health system. J Korean Med Sci. 2013;28(5):693-9. DOI: 10.3346/jkms.2013.28.5.693
• Referans 9. Hogan AR, Zhuge Y, Perez EA, Koniaris LG, Lew JI, Sola JE. Pediatric thyroid carcinoma: incidence and outcomes in 1753 patients. J Surg Res. 2009;156(1):167-72. DOI: 10.1016/j.jss.2009.03.098
• Referans 10. Alkhars A, Abouzayd M, Rouf CE, Lardy H, Bakhos D, Pondaven-Letourmy S, et al. Pediatric thyroid surgery: experience in 75 consecutive thyroidectomies. Eur Arch Otorhinolaryngol. 2019;276(1):217-22. DOI: 10.1007/s00405-018-5188-9
• Referans 11. Richman DM, Benson CB, Doubilet PM, Peters HE, Huang SA, Asch E, et al. Thyroid Nodules in Pediatric Patients: Sonographic Characteristics and Likelihood of Cancer. Radiology. 2018;288(2):591-9. DOI: 10.1148/radiol.2018171170
• Referans 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(6):869-77; discussion 77. DOI: 10.1016/j.surg.2008.08.033
• Referans 13. Kundel A, Thompson GB, Richards ML, Qiu LX, Cai Y, Schwenk FW, et al. Pediatric endocrine surgery: a 20-year experience at the Mayo Clinic. J Clin Endocrinol Metab. 2014;99(2):399-406. DOI: 10.1210/jc.2013-2617
• Referans 14. Dream S, Wang R, Lovell K, Iyer P, Chen H, Lindeman B. Outpatient thyroidectomy in the pediatric population. Am J Surg. 2020;219(6):890-3. DOI: 10.1016/j.amjsurg.2020.03.025
• Referans 15. Baumgarten HD, Bauer AJ, Isaza A, Mostoufi-Moab S, Kazahaya K, Adzick NS. Surgical management of pediatric thyroid disease: Complication rates after thyroidectomy at the Children's Hospital of Philadelphia high-volume Pediatric Thyroid Center. J Pediatr Surg. 2019;54(10):1969-75. DOI: 10.1016/j.jpedsurg.2019.02.009
• Referans 16. de Jong M, Nounou H, Rozalén García V, Christakis I, Brain C, Abdel-Aziz TE, et al. Children are at a high risk of hypocalcaemia and hypoparathyroidism after total thyroidectomy. J Pediatr Surg. 2020;55(7):1260-4. DOI: 10.1016/j.jpedsurg.2019.06.027
• Referans 17. Zobel MJ, Long R, Gosnell J, Sosa JA, Padilla BE. Postoperative Hypoparathyroidism After Total Thyroidectomy in Children. J Surg Res. 2020;252:63-8. DOI: 10.1016/j.jss.2020.02.018
• Referans 18. Wu SY, Chiang YJ, Fisher SB, Sturgis EM, Zafereo ME, Nguyen S, et al. Risks of Hypoparathyroidism After Total Thyroidectomy in Children: A 21-Year Experience in a High-Volume Cancer Center. World J Surg. 2020;44(2):442-51. DOI: 10.1007/s00268-019-05231-4