Dr. Adam Craig Alder, MD

I appreciate your concerns about your child's health. In general, thyroid nodules in children tend to be malignant more frequently than in adults. However, the majority of thyroid conditions in children are benign. If the nodules do turn out to be malignant, then it is likely that further surgical and medical care will be needed. Identifying a team of physicians and surgeons that have experience with thyroid malignancies and who can support you and your son through this experience is important. It is likely that your son will need to start some type of thyroid hormone replacement and will need to have monitoring of thyroid hormone and thyroid function related levels checked to be sure that his health is being supported. You will need to ensure that you follow up with your care team as they monitor for growth or spread of any suspicious tissue. Overall, thyroid malignancies tend to be less aggressive than some other types of cancer.

In 2019 there is evidence that supports both approaches: operating and waiting. The most important thing for you to know is that both approaches are safe but have unique risks. Feel free to ask your physician team questions about why they are choosing to wait.

The most important urgent treatment is to give antibiotics. If the antibiotics are started, then the timing of the operation to remove the appendix, appendectomy, is much less important. All medical and surgical treatments carry risk. The risk of the operation include more common things like wound infection. Rare complications include pneumonia, allergic reactions to the anesthetic, intra-abdominal injuries, and some other things. Hundreds of thousands of people have undergone appendectomy and the overall risks are low.

In general, children recover quite quickly from surgical procedures. Children with appendicitis that is complex or perforated may take a while to recover from the illness that is unrelated to the operation. You should talk to your surgeon about how quickly your child should return to regular activities.

Any surgical procedure may be risky which is why selecting a team that is dedicated to the care of children is important. In general, a previously healthy child with acute appendicitis will recover back to full activity and health after the general anesthesia used during an appendectomy. Make sure you ask your anesthesia team all of your questions and they will be the best resource for the specifics of the risks of anesthesia.

I would defer to the surgeon. They are going to be the best source of information about when to time the procedure. Waiting may have significant advantages for your child and the surgery team.