R. Roy1, A. Babu2, Z. Song1, S. Vinjamuri3, O.E. Anyagwa4, B. Lindeman1, J. Fazendin1, A. Gillis1, H. Chen1 1University Of Alabama at Birmingham, Birmingham, Alabama, USA 2Our Lady of Fatima University, College of Medicine, Valenzuela City, Philippines 3Gandhi Medical College, Secunderabad, India 4New Vision University, Tbilisi, Georgia
Introduction: Surgical management plays a crucial role in managing thyroid disease in the pediatric population as evidenced by the increasing volume of such cases over the years. This study aims to evaluate the outcomes of thyroid surgery in children and adolescents across several institutions.
Methods: A comprehensive literature search for single institutional studies was performed across PubMed, Science Direct, Embase, Scopus and Google Scholar. Key variables like mean hospital stay and both transient and permanent complications were recorded. Transient hypocalcemia/ hypoparathyroidism was defined as a drop in serum calcium below laboratory reference range post-thyroidectomy that resolved within 6 months. Transient laryngeal nerve injury was characterized by hoarseness or dysphonia arising from neuropraxia or trauma to the nerve that resolved within 6 months post surgery. Complications persisting beyond 6 months were classified as permanent.
Results: A total of 2,339 studies were retrieved through our search strategy across 5 databases. Excluding duplicates, the remaining studies were screened resulting in 88 studies being selected for a full text review. Fifty six studies were excluded due to lack of outcome specific data leaving a total of thirty two studies that were included amounting up to 2,747 patients with a mean of 86 patients per study. The overall weighted mean age of patients in our study pool was 12.9 ± 4.1 (95% CI: 12.8 -13.1) years. Mean hospital stay was 2.6 ± 1.9 (95% CI: 2.5 – 2.7) days. Common complications like transient hypocalcemia/ hypoparathyroidism was found in 24% (95% CI:0.2-0.3, I2=91%) and transient laryngeal nerve injury was 2% (95% CI:0.01-0.02, I2=35%) of patients. Permanent hypocalcemia/ hypoparathyroidism was found in 3% (95% CI:0.02-0.04, I2=65%) patients. Rare complications included permanent laryngeal nerve injury in 1% (95% CI:0.00-0.01) and hematoma formation in 1% (95% CI:0.00-0.01)
Conclusion: The reviewed studies emphasized the importance of experienced surgeons, meticulous techniques and the use of intraoperative nerve monitoring to reduce complications and improve outcomes in thyroid surgery. High volume centers and multidisciplinary care protocols are crucial for optimal outcomes, especially in pediatric patients.