Differentiated thyroid carcinoma: comparison of histopathologic characteristics, clinical course, and outcome between young children and adolescents

Abstract

Differentiated thyroid carcinoma is rare in patients younger than 21 years, especially in children, but it is associated with a greater risk of metastases and recurrence. The aim of our study was to compare the characteristics, clinical course, and outcome of the disease between young children (≤16 years) and adolescents (17-21 years). We reviewed the medical records of 62 young children and adolescents (47 females, 15 males, ≤21 years) with DTC who were diagnosed between 1990 and 2010 and admitted for radioiodine therapy, and compared the histopathologic features, amount and session(s) of radioiodine administration, and outcome in both groups. Young children presented with larger tumor size, more aggressive pathological features, higher incidence of locoregional and distant metastasis, and needed more admissions, and higher amounts of radioiodine for treatment. While there were more disease-free patients at the end of follow-up in the adolescents, the number of patients with stable or progressive disease was higher in younger group. Based on the results of our study, we support the more aggressive approach to DTC treatment in young children, including total thyroidectomy along with more extensive cervical lymph node dissection, L-T4 therapy in suppressive doses, and multiple sessions of postsurgical radioiodine therapy as necessitated.

Young age is associated with increased rates of residual and recurrent paediatric differentiated thyroid carcinoma

“…There are significant distinctions in this cohort in terms of the pres- In contrast to other recent analyses, 14,15,17 we did not identify a difference in the rates of central or lateral neck LN metastases; however, the lymph node ratio was higher in children <12. A lymph node ratio >0.42 has previously been demonstrated, in an adult cohort, to be associated with elevated recurrence risk.…”

“…Despite a rising incidence of paediatric thyroid cancer, few studies have defined the differences in thyroid cancer in children as a function of age . Recent American Thyroid Association (ATA) Guidelines for Management of Children with Thyroid Nodules and Differentiated Thyroid Cancer acknowledge that “it remains unclear if younger children (<10‐15 years of age) are at greater risk for more extensive disease or higher rates of recurrence.” Younger children may have more extensive and aggressive disease at presentation or may harbour occult disease that surfaces following primary therapy . In one study, younger children received higher cumulative doses of radioactive iodine.…”

“…Recent American Thyroid Association (ATA) Guidelines for Management of Children with Thyroid Nodules and Differentiated Thyroid Cancer acknowledge that “it remains unclear if younger children (<10‐15 years of age) are at greater risk for more extensive disease or higher rates of recurrence.” Younger children may have more extensive and aggressive disease at presentation or may harbour occult disease that surfaces following primary therapy . In one study, younger children received higher cumulative doses of radioactive iodine. In another retrospective series, age was found to be the major determinant of recurrence in paediatric DTC .…”

Predictive Factors for Recurrence of Papillary Thyroid Carcinoma in Children and Adolescents

“…Thyroid carcinoma is rare in children and adolescents, which accounts for 0.5%–3% ( 9 ), but the occurrence has been rising recently. Children and adolescents with PTC have unique biological characteristics; it has been proposed in the literature that they are more likely to have stronger invasiveness, higher LNM, and recurrence rate ( 10 , 11 ). Therefore, it is necessary to do further research on the clinicopathological characteristics and prognosis of this age group to provide evidence for the clinical development of diagnosis and treatment plans.…”

Aggressiveness of Differentiated Thyroid Carcinoma in Pediatric Patients Younger Than 16 years: A Propensity Score-Matched Analysis

“…The biological behavior of pediatric thyroid cancer is known to be different from that in adult patients; it has been suggested that it presents at a more advanced stage in prepuberty than in puberty ( 17 ). Younger pediatric patients are associated with a larger mean tumor size, more aggressive pathological features, and higher incidence of loco-regional and distant metastasis ( 18 , 19 ). The patients first presented with symptoms such as neck swelling with a palpable mass or discomfort ( 3 , 20 ).…”