Introduction:
Surgical diseases of the thyroid gland in children are rare in comparison with those in the adult population. The aim of the study was to assess clinical aspects of thyroid follicular adenoma in children and attempt to develop a management algorithm that is useful in clinical practice.

Material and methods:
The clinical database of all children operated on due to thyroid disease in the years 1993–2018 at the university pediatric surgical center was reviewed. The children in whom the postoperative histology report showed follicular adenoma were selected and their medical files were analyzed in detail. Clinical course of the disease, medical and family history, results of imaging studies, details of surgical management and final outcome were assessed in each case.

Results:
Among 183 children operated on for thyroid pathology in the study period there were 56 patients with follicular adenoma (30.6%). Their age ranged from 7 to 18 years. Seven patients were found to be hypothyroid and a further seven showed hyperthyroid status initially. Ultrasound scan showed a solitary nodule in 37 children (66.1%). Multiple nodules in one lobe were detected in 5 patients, while a further 14 children showed bilateral thyroid pathology. The result of preoperative cytologic examination was suspicious in 12 children (21.4%). All children were subjected to operative management. Forty-two children (75%) underwent at least unilateral total lobectomy. No patient showed a recurrent thyroid disease.

Conclusions:
Follicular adenoma in children presents a wide clinical and morphological spectrum. High incidence of associated diseases of other systems and congenital anomalies of the thyroid gland may indicate a complex etiology of follicular adenoma with participation of still unknown endogenic factors in children.