Clinical features of thyroid cancer in paediatric age. Experience of a tertiary centre in the 2000–2020 period

Abstract

Purpose. To describe the clinical features of a paediatric cohort affected by differentiated thyroid cancer (DTC) followed in a tertiary Department of Paediatric Endocrinology.Methods. Clinical data of 41 patients affected by DTC in the 2000-2020 period were reviewed.Results. The main risk factor was autoimmune thyroiditis (39%). Cytological categories were TIR3b in 39%, TIR4 in 9.8%, TIR5 in 51.2%. After total thyroidectomy, radioiodine treatment was performed in 38 subjects (92.7%). ATA low-risk category was assigned in 11 (30.5%), intermediate-risk category in 15 (41.7%), and high-risk category in 10 patients (27.8%). Age at diagnosis was 15.1 ± 0.92 years in low-risk category, 14.7 ± 0.59 in intermediate-risk category, 11.7 ± 0.89 years in high-risk category (p=0.01). TIR3b was manly observed in low-risk class (63.6%), while TIR5 was mainly reported in intermediate and highrisk class (60% and 80% respectively) (p= 0.04). Post-surgery stimulated thyroglobulin was increased in high-risk class (407.8±307.1 ng/ml) [p=0.04]. Tumour size was larger in high-risk category (42.6 ± 2.6 mm), than in low and intermediate-risk categories (19.4 ± 3.5 mm and 28.5 ± 3.9 mm, respectively) (p=0.008). Patients in intermediate and high-risk categories displayed more tumour multifocality (60% and 90% respectively) (p < 0.005). Disease relapse was mainly observed in high risk category (40%, p=0.04). Conclusion. DTC in childhood is more aggressive than in adults, but the overall survival rate is excellent. The therapeutic approach is still heterogeneous, especially in low-risk category. Further studies are needed to standardize management and reduce disease persistence in childhood.

Editorial: Thyroid nodules and tumors in childhood

“…Nodular thyroid disease in pediatric age displays a lower prevalence than in adulthood, even if to date no literature data have been produced on the global incidence and prevalence of this condition in childhood. Although most thyroid nodules in childhood are benign, they carry a risk of malignancy up to five times greater than that in adults ( 1 , 2 ). Most pediatric patients with differentiated thyroid cancer (DTC) present with an asymptomatic thyroid nodule found occasionally; not fully investigated are the association with autoimmune thyroiditis and the correlation with US changes over time ( 3 ).…”