In early October, a teenage boy noticed a lump on the right side of his neck. Suspecting lymphoma, the boy’s pediatrician sent him to an oncologist, who, after doing an ultrasound, diagnosed a thyroid mass. Upon hearing the news, the boy’s parents immediately called the Yale Pediatric Thyroid Center.
The two-year-old center is devoted exclusively to the care of infants, children and adolescents with thyroid conditions. Physicians treat a range of thyroid problems and use an innovative approach to surgery that reduces complications and improves outcomes.
A resource for complex cases
“The traditional model for a lot of subspecialties is that you see all kinds of conditions related to your field,” said Scott Rivkees, MD, a pediatric endocrinologist and director of the center. “I wanted to move beyond that model. Considering the institutional expertise in thyroid conditions we have here at Yale, it just made sense to develop a center specializing in pediatric thyroid problems.”
More than 1,000 patients have been treated at the center, with roughly 10 percent traveling from across the United States and other countries. The center also serves as a resource for physicians dealing with complex cases.
Pediatric and adult surgeons work together in the operating room
Much of the center’s success is due to its innovative approach of pairing a pediatric surgeon with an adult surgeon in the operating room. Since far fewer children than adults require thyroid surgery, the complication rate is significantly reduced by combining the expertise of a high-volume adult endocrine surgeon with that of a pediatric surgeon familiar with the unique challenges of young patients. These include differences in anatomical structure, fluid and electrolyte requirements and response to stress.
Robert Udelsman, MD, an internationally recognized endocrine surgeon, is the adult surgeon in the operating room. He performs the surgeries with Christopher Breuer, MD, the center’s pediatric thyroid surgeon.
“Children are not just little adults, so it makes sense to link up our expertise,” Udelsman said. One of the biggest risks in any thyroid surgery is the accidental removal of the parathyroid gland. When that happens to an adult, the patient can be treated with calcium and vitamin D pills,” Udelsman said. “A child will be affected forever, particularly their growth and development. With kids the stakes are much higher. If the surgeon makes a mistake, the patient can end up short in stature and with all sorts of other problems.”
The adult/pediatric surgical team model is designed to improve outcomes and reduce complications. “We can tell parents, ‘You’re going to have one of most experienced adult endocrine surgeons and one of most experienced pediatric surgeons working together on your child,’” Udelsman said. “That’s the type of reassurance that motivates parents to allow us to care for their children.”
“He’ll be just fine”
In the case of the teenager diagnosed with the thyroid mass, a biopsy showed that the patient had papillary thyroid cancer that had spread to lymph nodes in his neck. Following the diagnosis, the family met with Breuer to discuss the boy’s treatment.
A few weeks later, delicate surgery that included a thyroidectomy and removal of the lymph nodes in the neck was performed by Breuer and Udelsman, followed by three weeks of radioactive iodine treatment.
“With the proper surgery and follow-up treatment, the fellow has an excellent long-term prognosis,” Rivkees said. “We’ll be keeping a very close eye on him to make sure there’s no tumor recurrence, but there’s every reason to believe that he’ll be just fine.”