A prospective study of thyroid nodular disease in children and adolescents in western Poland from 1996 to 2000 and the incidence of thyroid carcinoma relative to iodine deficiency and the Chernobyl disaster

Niedziela, Marek; Korman, E; Breborowicz, D; Trejster, E; Harasymczuk, Jerzy; Warzywoda, Małgorzata; Rólski, M; Bręborowicz, J

doi:10.1002/pbc.10421

Cited by 43 publications

(33 citation statements)

References 38 publications

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“…Of all the patients operated on in our hospital in the years 1996ÿ2000, 83.2% were clinically euthyroid, a finding similar (86.5%) to that in a group of cancer patients (Niedziela 2002, Niedziela et al 2004.…”

Section: Clinical Examinationsupporting

confidence: 61%

“…Normal thyroid hormone levels predominated (86.5%) in all our patients (Niedziela 2002, Niedziela et al 2004.…”

Section: Laboratory Testsmentioning

confidence: 59%

“…However, in the majority of our children who were operated on, the tumor was localized within the right lobe (68.4%), (Niedziela 2002, Niedziela et al 2004. Furthermore, 66.1% of the benign lesions and 75.5% of thyroid carcinomas in the group were also localized in the right lobe.…”

Section: Clinical Examinationmentioning

confidence: 99%

“…I would propose a diagnostic protocol ( Fig. 1) based on the increasing numbers of children with TND who were diagnosed in Poland, a country with endemic goiter due to iodine deficiency (Korman et al 1999, Niedziela 2002, Niedziela et al 2004. With this protocol many of the patients are qualified for surgery because of the high prediction for thyroid neoplasia.…”

Section: Introductionmentioning

confidence: 99%

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Pathogenesis, diagnosis and management of thyroid nodules in children

Niedziela¹

2006

Endocr Relat Cancer

297

291

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According to the literature thyroid nodules are quite rare in the first two decades of life. However, there are some exceptions, relating to areas with an iodine deficiency or affected by radioactive fallout, where the risk of nodules and carcinomas is increased. Therefore, it is a great challenge for the physician to distinguish between benign and malignant lesions preoperatively, and not only in these areas of greater risk. A careful work-up, comprising the patient's history, clinical examination, laboratory tests, thyroid ultrasound, scintigraphy, fine-needle aspiration biopsy (FNAB) and molecular studies, is mandatory to improve the preoperative diagnosis. The differential diagnosis should also include benign thyroid conditions such as: (i) congenital hypothyroidism due to dyshormonogenesis or ectopy, (ii) thyroid hemiagenesis, (iii) thyroglossal duct cyst, (iv) simple goiter, (v) cystic lesion, (vi) nodular hyperplasia, (vii) follicular adenoma, (viii) Graves' disease and (ix) Hashimoto thyroiditis, all of which can predispose to the development of thyroid nodules. The majority of thyroid carcinomas derive from the follicular cell (papillary, follicular, insular and undifferentiated (or anaplastic) thyroid carcinoma), whereas medullary thyroid carcinoma derives from calcitonin-producing cells. Inherited forms of thyroid cancer may occur, especially in relation to medullary thyroid carcinoma. FNAB is a critical factor in establishing the preoperative diagnosis. However, we should keep in mind the fact that a conventional cytological evaluation can miss the neoplastic nature of a lesion and the employment of immunocytochemical and molecular studies of aspirates from FNAB can give us a more precise diagnosis of neoplasia in thyroid nodules once they are detected.

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Section: Clinical Examinationsupporting

confidence: 61%

“…Normal thyroid hormone levels predominated (86.5%) in all our patients (Niedziela 2002, Niedziela et al 2004.…”

Section: Laboratory Testsmentioning

confidence: 59%

Section: Clinical Examinationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pathogenesis, diagnosis and management of thyroid nodules in children

Niedziela¹

2006

Endocr Relat Cancer

297

291

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“…1). Although the very low thyroid cancer incidence in children precludes a definitive evaluation, most authors agree that from 1975 to 1995, incidence rates in the <20-year-old population remained rather stable in the US, Great Britain and Germany (Harach & Williams 1995, Bernstein & Gurney 1999, Farahati et al 2004, though not completely without fluctuation (Niedziela et al 2004, Leenhardt et al 2004.…”

Section: Epidemiology Of Juvenile Dtcmentioning

confidence: 99%

Juvenile differentiated thyroid carcinoma and the role of radioiodine in its treatment: a qualitative review

Jarząb¹,

Handkiewicz-Junak²,

Włoch³

2005

Endocr Relat Cancer

169

160

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Well under 15% of differentiated thyroid carcinoma (DTC) is diagnosed at £18 years of age. The population is heterogenous and the differences between prepubertal children and pubertals and adolescents are to be considered. Although very little has been reported on children with sporadic DTC under the age of 10 years, juvenile DTC has at least some undeniable differences with adult DTC: (1) larger primary tumor at diagnosis; (2) metastatic pattern and features, namely: (a) greater prevalence of neck lymph node and distant metastases at diagnosis, (b) lungs almost the sole distant metastatic site, (c) pulmonary metastases nearly always functional; (3) closer-to-normal and more frequent sodium-iodide symporter (NIS) expression; and (4) higher recurrence rate but longer overall survival. These differences are especially distinct in prepubertal children. The goals of primary treatment of juvenile DTC are to eradicate disease and extend not only overall, but recurrence-free survival (RFS). Extending RFS is itself a desirable goal in children because it improves quality-of-life, alleviates anxiety during psychologically formative years, reduces medical resource consumption, and may increase overall survival. Primary treatment of DTC generally comprises a combination of surgery, radioiodine ( 131 I) ablation, and thyroid hormone therapy applied at varying levels of intensity. Therapeutic decision-making must rely on retrospective adult and/or pediatric outcome studies and on treatment guidelines formulated mostly for adults. Differences between juvenile and adult DTC and physiology dictate distinct treatment strategies for children. We, and many others, advocate a routine intensive approach because of the more advanced disease at diagnosis, propensity for recurrence, and greater radioiodine responsiveness in children, as well as published evidence of significant survival benefits, especially regarding RFS. This intensive approach consists of total thyroidectomy and central lymphadenectomy in all cases, completed by modified lateral lymphadenectomy when necessary and followed by radioiodine administration. However, absence of prospective studies and of universal proof of overall causespecific survival benefits of this approach have led some to propose more conservative strategies. Most European centers give radioiodine ablation to the vast majority of juvenile DTC patients. Ablation seeks to destroy any residual cancer, including microfoci, as well as healthy thyroid remnant. Large studies have documented the procedure to decrease cause-specific death rates and, in children, to significantly lessen locoregional recurrence rates (by factors of 2-11) independent of the extent of surgery. There is universal agreement on treating inoperable functional metastases with large radioiodine activities. Treatment is especially effective in small tumor foci up to 1 cm in diameter, and should be administered every 6-12 months until complete response, loss of functionality, or attainment of cumulative activities between 18.5-3...

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