OUTCOMES OF THYROID SURGERY IN CHILDREN

43. Ulusal Çocuk Cerrahisi kongresi ve Mısır Çocuk Cerrahisi ortak kongresi, İstanbul, Türkiye, 21 - 24 Ekim 2026, ss.157-158, (Özet Bildiri)

Objective: Pediatric thyroid diseases are less common than those in adults but carry a substantially higher risk of

malignancy. This study aimed to evaluate the contribution of preoperative ultrasonography (USG) and fine-needle

aspiration biopsy (FNAB) to surgical decision-making, the role of intraoperative frozen section analysis in determining

the extent of thyroidectomy, and the concordance between preoperative, intraoperative, and final histopathological

findings.

Materials and Methods: A retrospective review was conducted of 50 pediatric patients who underwent thyroid surgery

between January 2009 and June 2026. Demographic characteristics, presenting symptoms, family history, preoperative

USG, FNAB and frozen section findings, surgical procedures, postoperative histopathological diagnoses, and follow-up

data were analyzed.

Results: The mean age was 14.08 ± 1.78 years, and 44 patients (88%) were female. Final histopathological examination

demonstrated malignancy in 35 patients (70%) and benign pathology in 15 (30%). Papillary thyroid carcinoma was the

most common malignant diagnosis, whereas diffuse thyroid disease and oncocytic adenoma were the most frequent

benign pathologies. Preoperative USG was available for all patients, while five underwent surgery without FNAB.

Ultrasonographic features associated with malignancy included microcalcifications, irregular margins, solid hypoechoic

nodules, hypervascularity, and pathological cervical lymph nodes. However, malignancy was also identified in five

patients with benign USG findings. FNAB was classified according to the Bethesda System. Bethesda V–VI categories

showed 100% concordance with final histopathology, whereas malignancy was detected in eight patients classified as

Bethesda I–IV. Frozen section findings were largely consistent with permanent histopathology; however, six patients

with benign frozen section results required completion thyroidectomy after malignancy was identified on permanent

examination. No permanent recurrent laryngeal nerve injury or permanent hypocalcemia occurred.

Conclusion: The malignancy rate of pediatric thyroid nodules was 70%, consistent with the high rates reported in the

literature. USG and Bethesda-based FNAB are valuable for estimating malignancy risk, but benign imaging or cytological

findings do not exclude malignancy. Surgical decisions should therefore integrate clinical, radiological, and cytological

findings. Frozen section analysis is useful for guiding the extent of surgery, although definitive diagnosis should rely on

permanent histopathological examination.