Differentiated thyroid carcinoma in children: A retrospective analysis of 125 pediatric cases from a single institution in India

Abstract

Background: Thyroid carcinoma (TC) is extremely rare in children. We assessed the clinicopathological features, outcomes, recurrence pattern, and associated risk factors of differentiated thyroid carcinoma (DTC).Methods: Children aged ≤14 years, pathologically diagnosed as DTC at a tertiary cancer institute between January 1998 and December 2015 were retrospectively analyzed. Survival outcomes were estimated using the Kaplan-Meier method.Results: During 18 years, 125 children with DTC were treated with a male:female ratio of 1:2.3. The median age was 12 years (2-14 years). Anterior neck swelling was the commonest presentation (72.8%). Histopathology revealed papillary thyroid carcinoma (PTC) in 123 children (98.4%). Extrathyroidal extension was seen in 32 children (25.6%). Sixty-eight children (54.4%) had nodal metastases and seven had distant metastasis. Relapse developed in 12 children. All were salvaged with subsequent surgery and radioiodine therapy. Eight children had persistent disease and one had a second malignant neoplasm. The median follow-up period was 9 years 1 month (1-20 years). Five-year recurrence-free survival (RFS) was 94.8% and 5-year overall survival was 100%. Larger tumors (p-value = .001), extrathyroidal extension (pvalue = .001), and nodal metastasis (p-value = .022) were significant predictors for RFS in univariate analysis.Conclusions: Pediatric DTC showed aggressive behavior characterized by a high rate of extrathyroidal extension and nodal and pulmonary metastasis. Persistent disease should be distinguished from recurrent disease as DTCs with metastatic disease remain stable for long time and usually respond well to radioiodine therapy. Our study reaffirmed favorable prognosis despite aggressive presentation and even after relapse.

Strategies for Radioiodine Treatment: What’s New

“…DTC in the pediatric and adolescent populations represents a rare disease with a higher rate of local and distant metastatic disease compared with adult DTCs [ 117 ]. Despite the aggressive presentation [ 117 , 118 , 119 , 120 , 121 , 122 ], pediatric DTCs are the most RAI-sensitive cancers, and a cure can be achieved in up to 52% of the cases [ 121 ]. These young patients have similar recurrence rates but lower specific mortality rates than adults in studies with long follow-up periods [ 117 , 118 , 119 , 120 , 122 ], and the rare cases of cancer-related deaths occur at an adult age [ 117 ].…”

“…The activity of RAI to be administered is calculated according to the body weight of the young patient (1–1.5 mCi/Kg) and the preferred preparation method is THW, although some experiences with rhTSH report non-inferior results [ 124 ]. Multiple RAI treatment courses are often necessary to obtain complete disease remission, and in a retrospective analysis of 125 children, 22% of patients required three or more RAI courses [ 120 ]. Considering metastatic cases, the cumulative RAI activity ranges from an average of 11.98 GBq to a maximum activity of 22.2 GBq, according to surveys [ 121 , 125 ], although Pires et al found no therapeutic benefit after 14.8 GBq of iodine administration in their cohort of 118 patients [ 126 ].…”

Factors associated with postoperative hypocalcemia following thyroidectomy in childhood

“…Hypoparathyroidism is defined by a decrease in serum calcium levels and PTH: it may occur as a transient form (TtHP), with progressive normalization within six months from surgical treatment, or permanent (PtHP), whenever the patient continues to require replacement therapy 2,7–9 . Numerous reports have attempted to correlate the incidence of post‐surgical complications with the type of thyroid disease associated, positive family history of thyroid cancer, gender of the patient, type of operation, cervical lymph nodes involvement, extrathyroidal invasion, thyroiditis, surgical expertise, and surgical timing 6,10–20 . Others have investigated the possible link between the development of hypocalcemia and some biochemical parameters, like preoperative vitamin D levels, postoperative PTH, and magnesium levels and pre‐ and postoperative serum calcium levels 21–35 .…”

“…2,[7][8][9] Numerous reports have attempted to correlate the incidence of post-surgical complications with the type of thyroid disease associated, positive family history of thyroid cancer, gender of the patient, type of operation, cervical lymph nodes involvement, extrathyroidal invasion, thyroiditis, surgical expertise, and surgical timing. 6,[10][11][12][13][14][15][16][17][18][19][20] Others have investigated the possible link between the development of hypocalcemia and some biochemical parameters, like preoperative vitamin D levels, postoperative PTH, and magnesium levels and pre-and postoperative serum calcium levels. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Calcium level lower than 1.9 mmol/L (7.61 mg/dL) after 24 h from thyroid surgery has been reported as predictive for the development of permanent hypocalcemia.…”

A ceRNA network mediated by LINC00475 in papillary thyroid carcinoma

“…PTC occurs in people of any age from the young to the elderly and is more prevalent in a female with a male-to-female ratio of 1:2.58 [ 3 , 4 ]. In recent years, with great advancements made in anticancer therapy, the prognosis of PTC patients has been significantly improved [ 5 ]. Nevertheless, the death rate of patients with thyroid carcinoma is still higher than that of patients with other endocrine tumors [ 6 , 7 ].…”