September 9, 2021

Study urges new pediatric thyroid surgery protocols

A Vanderbilt study is reinforcing the need to develop specific protocols for children, particularly concerning thyroid disease.


by Jessica Pasley

Physicians at Monroe Carell Jr. Children’s Hospital at Vanderbilt continue to highlight the differences in pediatric and adult treatment for similar illnesses.

Monica Lopez, MD, MS

In a recent study, conducted by a group of pediatric surgeons, findings reinforce the need to develop specific protocols for children, particularly concerning thyroid disease.

“Thyroid disease in kids is pretty rare, and there are many key differences between thyroid disease in adults and children,” said Monica Lopez, MD, MS, associate professor of Pediatric Surgery at Children’s Hospital. “Historically, the treatment of children with thyroid disease has been extrapolated from adult practice, which may not be appropriate.

“We already know that a thyroid nodule or a growth in adults has a small chance of harboring malignant cells of cancer,” she said. “But with children, it has a much higher likelihood. Because of these differences, we feel that the approach to pediatric care needs to be unique.”

The study — “Thyroid Surgery Outcomes at a Children’s Hospital: The Value of Multidisciplinary Team Approach” — was recently published in the Journal of Pediatric Surgery and shows the benefits of establishing a dedicated multidisciplinary team to care for children requiring thyroid surgery.

Traditionally, the American Thyroid Association established guidelines determining best outcomes were related to surgeries performed by high-volume surgeons or those with 30 or more endocrine cases a year.

As the incidence of pediatric thyroid disease is lower, concerns mounted over whether pediatric centers could attain this parameter and achieve excellent outcomes.

Lopez and her co-authors hypothesized that establishing specific metrics for pediatric cases would produce similar, if not better, outcomes as reported by adult centers.

“Our study found that by adopting a multidisciplinary approach to managing and evaluating children and adolescents with thyroid disease, we can achieve excellent long-term outcomes, which are comparable to leading adult specialty centers,” said Lopez, principal investigator of the study and vice chair for Quality and Evidence-Based Systems and director of Surgical Quality and Evidence-Based Programs at Children’s Hospital.

“We want to refine the definition and structure of what a center of excellence looks like as well as create unique, pediatric surgical quality metrics for thyroid surgeries that are not measured based on the adult perspective.”

The study found that centers incorporating the following protocols will ensure excellent outcomes:

  • Full spectrum, specialty pediatric care (anesthesia, radiology, surgery).
  • High-volume surgeons.
  • A multidisciplinary care approach.

A multidisciplinary approach would include teams that incorporate a pediatric surgeon, in some instance a pediatric head and neck surgeon, an endocrinologist, radiologist, pathologist and oncologist to provide care that results in an individualized, evidence-based care plan.

“The thyroid surgery experience at Children’s Hospital has been quite robust for more than two decades,” said Lopez. “The elements for a multidisciplinary team are in place, and the surgical expertise is here.

“How their first surgery is managed has a huge impact on the future health and long-term outcome for a child with thyroid cancer. We discovered that by implementing a dedicated surgeon model of thyroid disease and establishing this level of care, we achieved outcomes comparable to other high-volume pediatric and adult hospitals.”

The group reviewed thyroid operations performed between 2012 and 2019, examining cases, patient demographics, procedures, final diagnosis and results. During that period, 294 thyroid operations were performed on 279 patients.

Lopez said collaboration and communication were key factors in establishing a multidisciplinary approach to thyroid surgical care.

“We found that there was no magical number of cases a surgeon needed to perform, rather it was important to apply the multidisciplinary team approach concept, concentrate a surgeon’s experience, and standardize our algorithms to be the most beneficial for our pediatric population.”