The surgical treatment of Graves' disease in children and adolescents.

Abstract

Surgery as definitive treatment of pediatric Graves' disease is recommended for children and adolescents experiencing adverse effects of thionamides or disease relapse after at least 2 years of medical treatment. In addition, it is indicated in patients with a large goiter or with suspicious nodules. Total or near-total thyroidectomy should be performed, since subtotal thyroidectomy is associated with a high risk of relapse in this group. Patients should be referred to surgeons experienced in thyroid surgery because studies show that children and adolescents have a higher complication rate than adults. This is a retrospective matched case-control study. To analyze postoperative morbidity of children and adolescents (mean age = 15 ± 3 years) with Graves' disease who underwent total thyroidectomy between 2000 and 2010 in our department, a statistically identical group of adults (mean age = 46 ± 3) who also underwent total thyroidectomy for Graves' disease was matched as a control. End points were surgical complications like postoperative bleeding, transient and permanent recurrent laryngeal nerve palsy, and transient and permanent hypoparathyroidism. There was no significant difference in the mean operation time (137 ± 33 min), the rate of intraoperative parathyroid gland autotransplantation (9.5%), postoperative bleeding (4.8%), transient and permanent recurrent laryngeal nerve palsy (4.8 and 0%), and transient and permanent hypocalcemia (28.6 and 0%). Total thyroidectomy in children and adolescents with Graves' disease performed in a department that specializes in endocrine surgery is a safe procedure with no higher complication rates than total thyroidectomy in adults with Graves' disease.