Early diagnosis is a key objective in clinical medicine, and early detection of pathological short stature has tangible benefits for growth prognosis and the well-being of the child. Despite late diagnosis being common in growth disorders, programmes of height screening in primary care are not universal in developed countries and may be random or non-existent. A notable exception is automated growth monitoring in Finland, where an algorithm to detect abnormal growth is integrated into children's electronic health records, resulting in increased diagnoses of pathological short stature. Evidence-based anthropometric criteria for referral of short stature to secondary or tertiary care are now published, due largely to excellent studies in the Netherlands. Following referral of the short child, the protocol for laboratory investigations remains somewhat controversial because in healthy children their diagnostic yield can be too low for cost-effectiveness. However, outside of tertiary academic paediatric endocrinology centres, baseline screening tests are considered worthwhile and may speed up diagnosis and treatment. Finally, auxological cut-offs cannot replace good clinical practice, and the understanding that early and effective management depends on commitment to a diagnosis and individualisation of therapy in the short child cannot be overemphasised.
METHODS Study: Analytical and retrospective Patients files diagnosed with Thyroid Cancer treated during January 2010 to May 2019, who underwent surgical intervention and histopathological study were reviewed. Chi Square test were used as statistical analysis. A level of significance p <0.001 was established. INTRODUCTION: Cancer thyroid in pediatrics is characterized by advanced presentation, coupled with frequent lymph nodal metastases and often pulmonary metastases. There are few reports on the rate of cancer and hypoparathyroidism in children. OBJECTIVE: Describe of pediatric thyroid cancer with particular emphasis on the clinical characteristics, risk factors associated and with treatment outcomes RESULTS 43 patients were included in the study 69.8% were female. Average age of 12 years (range 5 to 17 years). Association of cancer and thyroiditis 25% and Cancer with Graves Disease 2.3%. Histopathological diagnoses of thyroid cancer: 86% papillary, 2.3% follicular, 11.6% medullary, 69.8% patients presented with metastases, most often lymph node (46.5%), pulmonary (2.3%) and pulmonary plus lymph node (23.3%), 11.6% patients do not present metastasis and 16.3% without data. Surgical interventions: only thyroidectomy 16.3%, Hemitiroidectomy 4.7%, total thyroidectomy with lymph node emptying 74% and modified radical neck dissection 5%.In 16% of the patients, second surgery was required after the histopathological report. Post-surgical hypoparathyroidism was recorded in 27 patients (62%): transitory in 11 (25%) and 16 (37%) permanent. Biochemical variables: (N /%/ Hypoparathyroidism /NO hypoparathyroidism) of 18 patients with post-surgical PTH <10 pg/ml (18/42%/17/1) 17 of them presented post-surgical hypoparathyroidism (P <0.001), PTH >10 pg/ml (13/30%/9/4), and without post-surgical measurement of PTH (12/28% / 6/6). Post-surgical ionized calcium <4mg/dl in 29 patients of which 22 had hypoparathyroidism (P <0.001) (29 / 67.4% / 22/7), with calcium >4 mg/dL (14 / 32.6% / 9/5). 21 patients with seric calcium <8mg/dl 20 with hypoparathyroidism. (21/48%/ 20/1) (P <0.001). Seric calcium >8 (16/37%/9/7) without measurement data. Serial calcium in 6 patients (6/15% / 3/3). Postoperative positive thyroglobulin parameter was presented as an risk factor for complication and metastases OR 1.42 (1-1.6) Regarding iodine treatment, 29 patients received an average dose of 200 (range 100- 720 milicuries mCi). CONCLUSIONS Papillary cancer is the most common type in pediatric patients, evidence of metastases find in 69.8% most frequent lymph node, postoperative thyroglobulin OR 1.42. They should always be considered in the management of these patients. As a post-surgical complication, there is an increased risk to present hypoparathyroidism when PTH less < 10 pg / ml, post-surgical ionized calcium < 4 mg/dl and serum calcium <8 mg/dl.
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