The principles of surgery for thyroid cancer in children are similar to those for adults
Differentiated thyroid cancer (DTC) generally begins with thyroidectomy (removal of bilateral thyroid lobes and isthmus). The American Thyroid Association (ATA) and European, Thyroid, Association (ETA) guidelines recommend that preoperative ultrasound be performed in both children and adults to identify the presence or absence of metastatic lymph nodes on both sides or in the middle of the neck.
In addition, physicians do examine lymph nodes during surgery, but B ultrasound is often better suited to detect small lymph node metastases than intraoperative exploration.
During surgery, depending on the size of the thyroid cancer lesion, whether lymph node metastases are present, and whether the cancer has penetrated the envelope of the thyroid and involved the surrounding neck tissue, the surgeon may change the original scope of the surgery. For thyroid cancers that have involved neck tissue, surgery can usually remove the tumor without damaging the muscles and nerves needed for vocalization.
The surgeon will remove lymph nodes that look abnormal or have biopsy-proven metastases. In the past, doctors removed only the lymph nodes suspected of metastasis, which was called selective lymph node dissection. Currently, both US and European guidelines recommend that whenever a metastatic lymph node is found, all lymph nodes in the area where the lymph node is located should be removed unilaterally or bilaterally.
If thyroid cancer is very aggressive, some surgeons will prophylactically clear the central group of lymph nodes in the neck even if metastasis is not determined during surgery. In most cases, however, in children with DTC, this is not appropriate if lymph node metastasis has not been confirmed.
What are the risks of thyroid cancer surgery in children?
The risks associated with thyroid cancer surgery in children are similar to those in adults: the risks associated with surgery are highest in children younger than 4 years of age; postoperative outcomes are significantly better in children older than 10 years.
Risks of surgery include:
- Damage to the recurrent laryngeal nerve: This causes vocal changes, but this is usually temporary and only in rare cases permanent. There are measures that may improve this.
- Hypocalcemia due to damaged parathyroid glands: Patients with hypoparathyroidism need to take calcium and vitamin D supplements for 2 to 4 weeks, but it is important to note that surgery may also lead to permanent hypothyroidism.
- Infection: A rare complication that can be treated with antibiotics.
- Bleeding: a rare complication that can be intervened intraoperatively or postoperatively.
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