Can you suggest some surgeons for pediatric prophylactic thyroidectomy in India?

Pediatric Prophylactic Thyroidectomy in India: Surgeon Recommendations

For pediatric prophylactic thyroidectomy in India, you should seek a high-volume thyroid surgeon with specific experience in pediatric thyroid surgery, ideally working as part of a multidisciplinary team at a tertiary care center.

Key Considerations for Selecting a Surgeon

Surgeon Experience and Volume

• High-volume thyroid surgeons have significantly lower complication rates in pediatric thyroidectomy 1
• Pediatric thyroidectomy carries higher risks of complications compared to adult procedures, including recurrent laryngeal nerve injury and hypoparathyroidism 1
• Surgeons who perform more than 100 thyroidectomies per year have the lowest overall complication rate (4.3%), while those performing fewer than 10 annually have four times as many complications 2

Ideal Surgical Team

• The optimal approach involves a surgeon with:

  • Extensive experience in pediatric thyroid surgery
  • High annual volume of thyroid procedures
  • Access to a multidisciplinary team

• The surgical team should include 1, 3:

  • Pediatric endocrinologists
  • Pediatric anesthesiologists
  • Nuclear medicine physicians
  • Pathologists with expertise in thyroid disease

Surgical Specialty Considerations

• Pediatric thyroidectomies are typically performed by:

  • General surgeons with thyroid expertise
  • Otolaryngologists with thyroid expertise
  • Pediatric general surgeons
  • Pediatric otolaryngologists 3

• A combined approach of a pediatric surgeon and a high-volume thyroid surgeon may be particularly beneficial 3

Specific Recommendations for India

Centers of Excellence

• Look for tertiary care centers in major cities with:
  • Dedicated thyroid surgery programs
  • Multidisciplinary thyroid teams
  • High surgical volumes
  • Experience with RET mutation cases

Questions to Ask Potential Surgeons

1. How many pediatric thyroidectomies do you perform annually?
2. What is your complication rate for recurrent laryngeal nerve injury and hypoparathyroidism?
3. Do you work with a multidisciplinary team that includes pediatric specialists?
4. Do you have experience with prophylactic thyroidectomy specifically for MEN2/RET mutations?
5. What is your protocol for preserving parathyroid function in children?

Importance of Timing for Prophylactic Thyroidectomy

The timing of surgery is critical based on the specific RET mutation:

• For highest risk mutations (MEN 2B - codons 918,883): Total thyroidectomy during the first year of life 2, 4
• For high risk mutations (MEN 2A - codon 634): Total thyroidectomy by age 5 years 2, 4
• For moderate risk mutations: Surgery may be delayed with appropriate surveillance 2, 4

Surgical Outcomes and Complications

• Early prophylactic thyroidectomy has excellent outcomes with 99.1% normalization of calcitonin levels 5
• Complication rates increase with age at surgery:
  • Hypoparathyroidism occurs in 32% of older adolescents versus 3% in the youngest children 5
  • Recurrent laryngeal nerve palsy is more common with central neck dissection 5

Conclusion

When seeking a surgeon for pediatric prophylactic thyroidectomy in India, prioritize high-volume thyroid surgeons with specific pediatric experience at major tertiary centers. The surgeon's experience and case volume are more important determinants of outcomes than their specific surgical specialty. Ideally, the procedure should be performed at a center with a multidisciplinary team approach to ensure the best possible outcomes for your child.