[Q] If thyroidectomy is chosen as treatment for GD in children, how should it be accomplished?
[Q1] Preparation of children with GD for thyroidectomy
- RECOMMENDATION 62
Children with GD undergoing thyroidectomy should be rendered euthyroid with the use of methimazole. Potassium iodide should be given in the immediate preoperative period. 1/+00
Surgery is an acceptable form of therapy for GD in children. Thyroidectomy is the preferred treatment for GD in young children (<5 years) when definitive therapy is required, and the surgery can be performed by a high-volume thyroid surgeon. In individuals with large thyroid glands (>80 g), the response to 131I may be poor (64,65); surgery also may be preferable for these patients. When performed, near-total or total thyroidectomy is the recommended procedure (243).
Technical remarks: MMI is typically given for 1–2 months in preparation for thyroidectomy. Ten days before surgery, potassium iodide (SSKI; 50 mg iodide/drop) can be given as 3–7 drops (i.e., 0.15–0.35 mL) three times daily for 10 days before surgery.
- RECOMMENDATION 63
If surgery is chosen as therapy for GD in children, total or near-total thyroidectomy should be performed. 1/++0
- RECOMMENDATION 64
Thyroidectomy in children should be performed by high-volume thyroid surgeons. 1/++0
Surgical complication rates are higher in children than in adults, with higher rates in younger than in older children (194). Postoperatively, younger children also appear to be at higher risk for transient hypoparathyroidism than adolescents or adults (194).
In addition, complication rates are twofold higher when thyroidectomy is performed by pediatric or general surgeons who do not have extensive current experience in this procedure than when performed by high-volume thyroid surgeons (194). Further support for the notion that thyroidectomy for GD in children should be performed by experienced thyroid surgeons comes from reports of institutional experience showing low complication rates at high-volume centers (190,244). In circumstances where local pediatric thyroid surgery expertise is not available, referral of a child with GD to a high-volume thyroid surgery center that also has pediatric experience is indicated, especially for young children. A multidisciplinary health-care team that includes pediatric endocrinologists and experienced thyroid surgeons and anesthesiologists is optimal.