ESPE Yearbook of Paediatric Endocrinology

moab@chop.edu Pediatr Blood Cancer. 2022; 69: e29674. PMID: 35338690.

Brief Summary: Childhood cancer survivors (CCS), particularly those exposed to local irradiation, are at increased risk for thyroid disease and thyroid surgery. This retrospective, monocentric study compared rates of surgical complications among 42 CCS undergoing thyroid surgery compared to 596 non-CCS controls (sporadic/familial thyroid cancer, Graves’ disease, other benign thyroid conditions).

In the CCS group, median age at surgery was higher (17 vs 15 years) and the proportion of females was lower (55% vs 82%). 85% of patients underwent total thyroidectomy (vs 76% of sporadic/familial thyroid cancer group, 32% of benign conditions group). Only 43% of CCS underwent lymph-node dissection vs 74% of patients with sporadic/familial thyroid cancer. Median operative times in CCS group were shorter compared to patients with sporadic/familial thyroid cancer (92 min vs 130 min for total thyroidectomy) and similar to patients with benign conditions. There was no difference in the proportions of low-intermediate- or high-risk disease, compared with sporadic/familial differentiated thyroid cancer (DTC). There was no differences in the incidence of postoperative complications after total or partial thyroidectomy between CCS and controls. CCS showed an increased incidence of transient but not permanent hypoparathyroidism (71% vs 25%).

Contrary to what might be expected, CCS did not show a higher risk of long-term complications from thyroid surgery, when treated by high-volume surgeons within a multidisciplinary team. The higher rates of transient hypoparathyroidism in CCS, according the Authors, were likely secondary to a greater proportion of total thyroidectomy and parathyroid auto-transplantation than in patients with benign conditions. The shorter operative times may be related to an earlier detection of thyroid nodules in CCS, due to the regular ultrasound screening performed in these patients.

The large sample size of CCS patients and controls represents the main strength of this study. Possible limitations are related to data source from a single-center experience, and to the retrospective design of the study.