Abstract
Introduction: Thyroid nodules (TN) are rare in children but carry a higher risk of malignancy (20–25%). Their management requires a multidisciplinary approach. This study aims to describe the specific features of surgical management of pediatric thyroid nodules.
Methods: A retrospective study including patients under the age of 18 who underwent surgical management for TN in the ENT and Head & Neck Surgery Department of Habib Bourguiba Hospital in Sfax, Tunisia, between 2010 and 2023. Our study aimed to describe the specific features of the surgical management of thyroid nodules in children and adolescents.
Results: Our study included 26 patients. The mean age at diagnosis was 15.4 years [8–18 years], with a sex ratio (M/F) of 0.44. Anterior neck swelling was the presenting symptom in 22 patients (84%). On cervical ultrasound, TN were classified as EU-TIRADS 5 in 30 % of cases, EU-TIRADS 4 in 12%, and EU-TIRADS 3 in the remaining cases.
All patients underwent surgical treatment: lobectomy with isthmectomy in 53% of cases and total thyroidectomy as first-line surgery in 47% of cases. A central neck dissection associated with bilateral functional cervical lymph
node dissection was performed in 12 % of cases. Final histological examination revealed benign nodules in 20 cases (76%) and malignant lesions in 6 cases (24%). These included 1 case of thyroid lymphoma (4%) and 5 cases (20%) of differentiated thyroid carcinoma. All patients with differentiated thyroid carcinoma received radioactive iodine (RAI) therapy combined with suppressive hormone therapy. The mean number of RAI treatments was 3. Postoperative recurrent laryngeal nerve palsy was observed in 2 patients (8%). The mean follow-up period was 25 months [6–120 months]. No deaths were reported.
Conclusion: TN in children and adolescents, although less common than in adults, require thorough evaluation due to a higher risk of malignancy. Close monitoring and multidisciplinary management contribute to optimizing prognosis and outcomes.
Keywords: Thyroid nodule, Child, Thyroidectomy
