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The incidence of thyroid nodules and thyroid cancer has increased over the last several decades. This change is influenced by several factors, to include the status of iodine sufficiency, access to the health care system and, perhaps most significantly, the increased use of radiological imaging. Thorough evaluation of a thyroid nodule includes review of the patient's medical and family history, followed by thyroid ultrasound and fine-needle aspiration biopsy. Similar to adults, the majority of nodules in children are benign; however, there is a 3- to 5-fold higher risk that a nodule found in a pediatric patient (≤18 years) will be malignant when compared to an adult. Differentiated thyroid carcinoma (DTC) is the most common malignancy with approximately 90-95% being papillary thyroid carcinoma and the remainder follicular thyroid carcinoma. With proper evaluation and management, the prognosis for pediatric patients with DTC is excellent; however, the risk of treatment complications and recurrence is relatively high. The development of pediatric specific guidelines for the evaluation and management of thyroid nodules and DTC as well as the creation of centers with surgical and medical expertise is crucial in order to optimize care and gain a better understanding of factors that impact disease-specific morbidity.
The incidence of thyroid nodules and thyroid cancer has increased over the last several decades. This change is influenced by several factors, to include the status of iodine sufficiency, access to the health care system and, perhaps most significantly, the increased use of radiological imaging. Thorough evaluation of a thyroid nodule includes review of the patient's medical and family history, followed by thyroid ultrasound and fine-needle aspiration biopsy. Similar to adults, the majority of nodules in children are benign; however, there is a 3- to 5-fold higher risk that a nodule found in a pediatric patient (≤18 years) will be malignant when compared to an adult. Differentiated thyroid carcinoma (DTC) is the most common malignancy with approximately 90-95% being papillary thyroid carcinoma and the remainder follicular thyroid carcinoma. With proper evaluation and management, the prognosis for pediatric patients with DTC is excellent; however, the risk of treatment complications and recurrence is relatively high. The development of pediatric specific guidelines for the evaluation and management of thyroid nodules and DTC as well as the creation of centers with surgical and medical expertise is crucial in order to optimize care and gain a better understanding of factors that impact disease-specific morbidity.
Thyroid nodules are frequent findings, especially when sensitive imaging methods are used. Although thyroid cancer is relatively rare, its incidence is increasing, particularly in terms of small tumors, which have an uncertain clinical relevance. Most patients with differentiated thyroid cancer exhibit satisfactory clinical outcomes when treatment is appropriate, and their mortality rate is similar to that of the overall population. However, relapse occurs in a considerable fraction of these patients, and some patients stop responding to conventional treatment and eventually die from their disease. Therefore, the challenge is how to identify the individuals who require more aggressive disease management while sparing the majority of patients from unnecessary treatments and procedures. We have updated the Brazilian Consensus that was published in 2007, emphasizing the diagnostic and therapeutic advances that the participants, representing several Brazilian university centers, consider most relevant in clinical practice. The formulation of the present guidelines was based on the participants' experience and a review of the relevant literature. Arq Bras Endocrinol Metab. 2013;57(4):240-64 Keywords Thyroid nodules; thyroid cancer; Brazilian consensus; update RESUMO Nódulos tireoidianos são muito frequentes, sobretudo quando se empregam métodos sensí-veis de imagem. Embora o câncer seja proporcionalmente raro, sua incidência vem aumentando, especialmente de tumores pequenos, cuja evolução clínica é incerta. A maioria dos pacientes com carcinoma diferenciado de tireoide evolui bem quando adequadamente tratada, com índices de mortalidade similares à população geral. Por outro lado, um percentual não desprezível apresenta recidivas e alguns eventualmente não respondem às terapias convencionais, evoluindo para óbito. Assim, o desafio é distinguir os pacientes merecedores de condutas mais agressivas e, ao mesmo tempo e não menos importante, poupar a maioria de tratamentos e procedimentos desnecessários. Atualizamos o Consenso Brasileiro publicado em 2007, ressaltando os avanços diagnósticos e terapêuticos que os participantes, de diferentes Centros Universitários do Brasil, consideram mais relevantes para prática clínica. A elaboração dessas diretrizes foi baseada na experiência dos participantes e revisão da literatura pertinente. Arq Bras Endocrinol Metab. 2013;57(4):240-64 Descritores
High-dose radioiodine treatment was well tolerated with satisfactory outcome in childhood patients with advanced differentiated thyroid carcinoma.
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