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<p>Pediatric papillary thyroid carcinoma (PTC) often presents with aggressive, advanced disease. When a tumor completely engulfs the recurrent laryngeal nerve (RLN), surgeons face a tough choice: shave the tumor to save the nerve, or cut the nerve to ensure all cancer is removed. Clear guidelines for this surgical dilemma in very young children are currently lacking. A 5-year old girl presented with a large goiter and palpable lymph nodes on both sides of her neck. Cytology confirmed PTC. She underwent a total thyroidectomy with bilateral central and lateral neck dissections. During the operation, we found the tumor completely wrapping around the left RLN. To make sure no microscopic cancer was left behind (stage pT3bN1b), we made the intentional decision to sacrifice the nerve. After surgery and radioiodine therapy, her scans showed no remaining cancer. Remarkably, despite losing the left recurrent laryngeal nerve, the child's voice recovered very well and is near-normal. Her wound was healed, and she is currently on thyroxine replacement. In young children with highly aggressive thyroid cancer, prioritizing complete tumor removal by sacrificing an involved RLN is a safe oncological choice. Because children have excellent vocal cord adaptation and neural plasticity, they can achieve impressive voice recovery even after a nerve is permanently removed.</p>

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Intentional Recurrent Laryngeal Nerve Sacrifice with Remarkable Vocal Compensation in Pediatric Papillary Thyroid Carcinoma: A Case Report

  • 期刊论文

  • 发表日期：

    2026年7月16日

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  • Shaheen Ayesha Nasirudeen,
  • Balaji Ranganathan,
  • Sriprakash Duraisamy,
  • Jeenat Malawat

摘要

Pediatric papillary thyroid carcinoma (PTC) often presents with aggressive, advanced disease. When a tumor completely engulfs the recurrent laryngeal nerve (RLN), surgeons face a tough choice: shave the tumor to save the nerve, or cut the nerve to ensure all cancer is removed. Clear guidelines for this surgical dilemma in very young children are currently lacking. A 5-year old girl presented with a large goiter and palpable lymph nodes on both sides of her neck. Cytology confirmed PTC. She underwent a total thyroidectomy with bilateral central and lateral neck dissections. During the operation, we found the tumor completely wrapping around the left RLN. To make sure no microscopic cancer was left behind (stage pT3bN1b), we made the intentional decision to sacrifice the nerve. After surgery and radioiodine therapy, her scans showed no remaining cancer. Remarkably, despite losing the left recurrent laryngeal nerve, the child's voice recovered very well and is near-normal. Her wound was healed, and she is currently on thyroxine replacement. In young children with highly aggressive thyroid cancer, prioritizing complete tumor removal by sacrificing an involved RLN is a safe oncological choice. Because children have excellent vocal cord adaptation and neural plasticity, they can achieve impressive voice recovery even after a nerve is permanently removed.