Surgical management of pediatric Graves’ disease: an effective definitive treatment (original) (raw)

Abstract

Purpose

The optimal treatment for pediatric Graves’ disease (GD) is controversial. Antithyroid drugs are often used initially, but they are associated with a high failure rate. Therefore alternative therapies have become important. In the present study, we analyze our institution’s experience regarding the safety and efficacy of thyroid surgery among pediatric patients with GD.

Methods

This is a retrospective chart review of 27 pediatric patients (age ≤ 18 years) with GD who underwent thyroid surgery between 1991 and 2009 at a single academic Institution. We recorded preoperative, intraoperative, and short-term postoperative data.

Results

All 27 patients were initially treated with thionamides. The high rate of hyperthyroidism relapse after discontinuation of medical treatment, age < 5 years, adverse reaction to medical therapy, severe ophthalmopathy, and patient preference justified the final decision to proceed with surgery as definitive therapy. All patients underwent total thyroidectomy. We had no mortality; surgical complications were rare: 4 (14.8 %) cases of transient hypocalcemia, 1 (3.7 %) of permanent hypocalcemia, 3 (11.1 %) of transient RLN neuropraxia, and 2 (7 %) of keloid scar. No bleeding, permanent RLN palsy or relapse hyperthyroidism were reported.

Conclusions

Surgical therapy for pediatric GD performed by experienced thyroid surgeons is a safe, definitive and cost-effective treatment.

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Abbreviations

ATD:

Antithyroid drug therapy

BMI:

Body mass index

GD:

Graves’ disease

RAI:

Radioactive iodine ablation

RLN:

Recurrent laryngeal nerve

TPOAb:

Thyroid peroxidase autoantibodies

TRAb:

Thyroid-stimulating hormone receptor antibodies

TT:

Total thyroidectomy

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Authors and Affiliations

  1. Department of Pediatric Endocrinology, San Raffaele Hospital, Vita-Salute San Raffaele University, Via Olgettina, 60, Milan, Italy
    Elena Peroni, Maria Cristina Vigone, Giuseppe Chiumello & Giovanna Weber
  2. Department of Surgery, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
    Maria Rachele Angiolini, Gilberto Mari & Edoardo Beretta

Authors

  1. Elena Peroni
  2. Maria Rachele Angiolini
  3. Maria Cristina Vigone
  4. Gilberto Mari
  5. Giuseppe Chiumello
  6. Edoardo Beretta
  7. Giovanna Weber

Corresponding author

Correspondence toGiovanna Weber.

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Peroni, E., Angiolini, M.R., Vigone, M.C. et al. Surgical management of pediatric Graves’ disease: an effective definitive treatment.Pediatr Surg Int 28, 609–614 (2012). https://doi.org/10.1007/s00383-012-3095-5

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