90th Annual Meeting Abstracts
Safety and Efficacy of Thyroidectomy for Graves Disease in Pediatric Patients
*Loren Berman, MD, *Scott Rivkees, MD, Julie Ann Sosa, MD, Robert Udelsman, MD, Christopher Breuer, MD
Yale University School of Medicine, New Haven, CT
Objective: To review the surgical outcomes of patients undergoing thyroidectomy for management of Graves disease at our pediatric thyroid center, and to determine the relative risks of this operation in the pediatric population compared to adults.
Design: Chart review, review of the literature.
Setting: Tertiary referral center.
Patients: Eleven patients had thyroidectomy for Graves disease. The majority were female (64%) and the median age was 5 years (range 3 to 16 years).
Interventions: Total thyroidectomy was performed on all patients.
Main Outcome Measures: Data on indications for surgery, post-operative course, and short and long-term complications were collected. These data were compared to literature-based values in adults and children.
Results: The most common indication for surgery in our series was intolerance of anti-thyroid medication due to allergy (36%) or toxicity (27%). The remaining patients had progression of symptoms while on anti-thyroid medications. The median length of stay was 1 day (range 1 to 3 days). Two patients (18%) experienced transient hypoparathyroidism. This is comparable to published rates of 14-21% in the adult literature. None of our patients had recurrent laryngeal nerve neuropraxia or bleeding complications.
Conclusions: Hyperthyroidism caused by Grave’s disease is a rare but serious disorder in children. Many children experience complications or progression of symptoms on medical anti-thyroid therapy. In contrast to adults, children rarely have spontaneous remission of hyperthyroidism, and definitive treatment is often required. Our series, along with a review of the literature, has shown that the incidence of serious complications in pediatric patients is low, and comparable to the adult population. We conclude that surgery for Grave’s disease is a safe option for pediatric patients.