Skip to main content

The Surgical Treatment of Graves’ Disease in Children and Adolescents

Abstract

Background

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.

Methods

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.

Results

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%).

Conclusion

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.

This is a preview of subscription content, access via your institution.

References

  1. Bauer AJ (2011) Approach to the pediatric patient with Graves’ disease: When is definitive therapy warranted? J Clin Endocrinol Metab 96(3):580–588

    PubMed  Article  CAS  Google Scholar 

  2. Lavard L, Ranlov I, Perrild H, Andersen O, Jacobsen BB (1994) Incidence of juvenile thyrotoxicosis in Denmark, 1982–1988. A nationwide study. Eur J Endocrinol 130(6):565–568

    PubMed  Article  CAS  Google Scholar 

  3. Kaguelidou F, Alberti C, Castanet M, Guitteny MA, Czernichow P, Leger J (2008) Predictors of autoimmune hyperthyroidism relapse in children after discontinuation of antithyroid drug treatment. J Clin Endocrinol Metab 93(10):3817–3826

    PubMed  Article  CAS  Google Scholar 

  4. Brix TH, Kyvik KO, Christensen K, Hegedus L (2001) Evidence for a major role of heredity in Graves’ disease: a population-based study of two Danish twin cohorts. J Clin Endocrinol Metab 86(2):930–934

    PubMed  Article  CAS  Google Scholar 

  5. Cappa M, Bizzarri C, Crea F (2010) Autoimmune thyroid diseases in children. J Thyroid Res 2011:675703

    PubMed  Google Scholar 

  6. Hung CS, Chang LY, Sui HH, Chao T, Van YH, Lo FS (2006) Clinical and laboratory findings at initial diagnosis in pediatric Graves’ disease in Taiwan. Acta Paediatr Taiwan 47(2):77–82

    PubMed  Google Scholar 

  7. Mauras N, Rogol AD, Haymond MW, Veldhuis JD (1996) Sex steroids, growth hormone, insulin-like growth factor-1: neuroendocrine and metabolic regulation in puberty. Horm Res 45(1–2):74–80

    PubMed  Article  CAS  Google Scholar 

  8. Rivkees SA, Sklar C, Freemark M (1998) Clinical review 99: the management of Graves’ disease in children, with special emphasis on radioiodine treatment. J Clin Endocrinol Metab 83(11):3767–3776

    PubMed  Article  CAS  Google Scholar 

  9. Rivkees SA, Dinauer C (2007) An optimal treatment for pediatric Graves’ disease is radioiodine. J Clin Endocrinol Metab 92(3):797–800

    PubMed  Article  CAS  Google Scholar 

  10. Sosa JA, Tuggle CT, Wang TS, Thomas DC, Boudourakis L, Rivkees S et al (2008) Clinical and economic outcomes of thyroid and parathyroid surgery in children. J Clin Endocrinol Metab 93(8):3058–3065

    PubMed  Article  CAS  Google Scholar 

  11. Rivkees SA (2010) Pediatric Graves’ disease: controversies in management. Horm Res Paediatr 74(5):305–311

    PubMed  Article  CAS  Google Scholar 

  12. Dralle H, Lorenz K (2010) Intraoperative neuromonitoring of thyroid gland operations: surgical standards and aspects of expert assessment. Chirurg 81(7):612–619

    PubMed  Article  CAS  Google Scholar 

  13. Thomusch O, Sekulla C, Machens A, Neumann HJ, Timmermann W, Dralle H (2004) Validity of intra-operative neuromonitoring signals in thyroid surgery. Langenbecks Arch Surg 389(6):499–503

    PubMed  Article  Google Scholar 

  14. Brent GA (2008) Clinical practice. Graves’ disease. N Engl J Med 358(24):2594–2605

    PubMed  Article  CAS  Google Scholar 

  15. Weetman AP (2000) Graves’ disease. N Engl J Med 343(17):1236–1248

    PubMed  Article  CAS  Google Scholar 

  16. Barnes HV, Blizzard RM (1977) Antithyroid drug therapy for toxic diffuse goiter (Graves disease): thirty years experience in children and adolescents. J Pediatr 91(2):313–320

    PubMed  Article  CAS  Google Scholar 

  17. Barrio R, Lopez-Capape M, Martinez-Badas I, Carrillo A, Moreno JC, Alonso M (2005) Graves’ disease in children and adolescents: response to long-term treatment. Acta Paediatr 94(11):1583–1589

    PubMed  Article  Google Scholar 

  18. Gorton C, Sadeghi-Nejad A, Senior B (1987) Remission in children with hyperthyroidism treated with propylthiouracil. Long-term results. Am J Dis Child 141(10):1084–1086

    PubMed  CAS  Google Scholar 

  19. Hamburger JI (1985) Management of hyperthyroidism in children and adolescents. J Clin Endocrinol Metab 60(5):1019–1024

    PubMed  Article  CAS  Google Scholar 

  20. Raza J, Hindmarsh PC, Brook CG (1999) Thyrotoxicosis in children: thirty years’ experience. Acta Paediatr 88(9):937–941

    PubMed  Article  CAS  Google Scholar 

  21. Lippe BM, Landaw EM, Kaplan SA (1987) Hyperthyroidism in children treated with long term medical therapy: twenty-five percent remission every two years. J Clin Endocrinol Metab 64(6):1241–1245

    PubMed  Article  CAS  Google Scholar 

  22. Spinelli C, Bertocchini A, Lima M, Miccoli P (2002) Graves-Basedow’s disease in children and adolescents: total vs subtotal thyroidectomy. Pediatr Med Chir 24(5):383–386

    PubMed  CAS  Google Scholar 

  23. Raval MV, Browne M, Chin AC, Zimmerman D, Angelos P, Reynolds M (2009) Total thyroidectomy for benign disease in the pediatric patient—feasible and safe. J Pediatr Surg 44(8):1529–1533

    PubMed  Article  Google Scholar 

  24. Sherman J, Thompson GB, Lteif A, Schwenk WF, van Heerden J, Farley DR et al (2006) Surgical management of Graves disease in childhood and adolescence: an institutional experience. Surgery 140(6):1056–1061

    PubMed  Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to C. Chiapponi or R. Ladurner.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Chiapponi, C., Stocker, U., Mussack, T. et al. The Surgical Treatment of Graves’ Disease in Children and Adolescents. World J Surg 35, 2428 (2011). https://doi.org/10.1007/s00268-011-1238-9

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s00268-011-1238-9

Keywords

  • Recurrent Laryngeal Nerve
  • Total Thyroidectomy
  • Recurrent Laryngeal Nerve Palsy
  • Subtotal Thyroidectomy
  • Permanent Hypoparathyroidism