The Canadian Pediatric Thyroid Nodule Study: an evaluation of current management practices

Background/Purpose: Thyroid nodules in children often require surgical treatment. We evaluated management practices for these across Canada. Methods: Patient records from 9 Canadian pediatric centers of children undergoing surgery for thyroid nodules over a 6-year period were reviewed. Demographics, presenting features, investigations, surgical treatment, pathology, and complications were assessed. Results: One hundred and forty-one patients were reviewed (75% female), of whom 117 presented with a palpable mass. Ultrasound and/or thyroid scintigraphy was the most commonly used preoperative imaging studies. Fine-needle aspiration cytology correlated with final pathology in 49% of cases. Overall, the rate of malignancy in this series was 43%, with half being papillary carcinoma. Thirty-two of 57 patients undergoing primary total thyroidectomy had a malignancy; 14 of these had positive preoperative fine-needle aspiration cytologies. Twenty of 71 patients undergoing initial hemithyroidectomy ± isthmusectomy had a malignancy. Seventeen of these went on to completion thyroidectomy and 3 had malignancy in the second specimen. Hypocalcemia and hoarseness occurred in 14 and 4 patients, respectively. Complications were more common after primary total thyroidectomy; none occurred in patients undergoing completion thyroidectomy. Conclusions: The incidence of malignancy in pediatric thyroid nodules is high, and the risk of surgical complications significant. With variable management practices across Canada, evidence-based guidelines for diagnosis and surgical treatment may be valuable.