Chirurgická léčba maligních nádorů štítné žlázy u dětí

Surgical Therapy of Malignant Tumors of Thyroid Gland in Children

Introduction:
Malignant tumors of thyroid gland in children are rare. The incidence has been reported around 1 : 1 000 000. The diagnostics of thyroid gland tumors in children includes endocrine examination (evaluation of funkcion of thyroid gland) and sonography of thyroid gland and neck including lymphatic nodes. Based on clinical picture and sonography of thyroid gland, the material for cytological examination in mostly sampled by a thin needle biopsy (puncture) (FNAB). The therapy of thyroid gland malignant tumorts includes several therapeutic modalities. The surgical method in case of malignant tumors is represented by a total thyreodectomy (TTE), extended in affected lymphatic nodes by the block dissection of cervical nodes. Another step in the treatment in the radiation therapy (administration of radioactive iodine, actinotherapy).

Material and methods:
In the years 1998-2005 surgical therapy was used to treat 21 children at the age 7-16 years for removal of thyroid gland, 14 of them for established malignity of thyroid gland. From the group with malignity, there were 7 boys (50%) and 7 girls (50%). In the evaluation of definitive histological examinations, papilary carcinoma was present most often. The first sing in 6 patients (43%) was the swelling of regional lymphotic nodes. In 7 patients (50%) there was a bundle in tyroid gland. One patients was incident for operation on the basis of genetic examination in the family with the MEN IIa syndrome. The surgical intervention represented total thyroidectomy in 11 patients. The total character of the intervention for histologically established malignity after a partial intervention was performed in two patients The extirpation of residues of tyroid tissue after TTE was performed in one patient. In nine patients with affection of lymphatic nodes, TTW was accompanied, by selective posterolateral modified block dissection with saving of all structures, the block dissection extended by region VI was made twice and upper mediastinal nodes once

Result:
In neither case was a paresis of either vocal corel. Transiend hypocalcemia was recorder there times, but normalization developed within thereweeks. The development of keloid cicatrice developed in one patient. Adjuvant treatment with radioactive iodines was indicated in 11 (79%) patients. External irradiation was not indicated at all. All patients are presently without any signs of the original disease.

Conclusion:
A complex examination of the patients with suspected malignity of thyroid gland should be performed in specialized centers with the collaboration of the endocrinologist and surgeon of thyroid gland - a specialist for child age, and possibly also oncologist and a radiotherapy specialist. The recommended therapy in malignant tumor of thyroid gland is based on radical inervention in the sense of total thyroidectomy. If the lymphatic nodes are affected, the selective, most frequently posterolateral block dissection with saving the structures is the only suitable method from the oncological point of view. The prognosis for children patients with differentiated carcinoma of thyroid gland, diagnosed in time and correctly treated is excellent.

Key words:
malignant tumor, thyroid gkand, children, total thyroidectomy.