Papillary Thyroid Carcinoma (PTC) in Children and Adults: Comparison of Initial Presentation and Long‐Term Postoperative Outcome in 4432 Patients Consecutively Treated at the Mayo Clinic During Eight Decades (1936–2015)

Abstract

Children, despite presenting with more extensive PTC when compared to adults, have postoperative recurrences at similar frequency, typically coexist with DM and die of PTC less often. Since 1976, both children and adults with MACIS <6 PTC have a <1% chance at 30 years of CSM; adults with higher MACIS scores (6 or more) have a 30-year CSM rate of 30%.

Thyroid cancer in adolescents and young adults

“…A TG level of 0–5 ng/ml a month after surgery is considered normal. Cardiac function and bone metabolism markers are checked periodically …”

“…Since its overall survival rate is among the highest, if not the highest, among all types of malignancies in AYAs, the treatment selected must be carefully considered relative to its acute, subacute, and delayed toxicities and complications. Most AYAs with TC are still treated according to approaches used in adult patients rather than per guidelines of the American Thyroid Association (ATA) . As reviewed here, the diagnosis of TC from a biopsy must be evaluated assiduously relative to its potential to be truly malignant, a problem that has been occurring worldwide …”

Overdiagnosis of Thyroid Cancer: Is This Not an Ethical Issue for Pathologists As Well As Radiologists and Clinicians?

“…19 Takano 20 offers an interesting theory about the natural history of thyroid cancer, and Japanese studies give evidence that PTC is a common childhood phenomenon. 21 Baseline US studies performed on children following the 2011 Fukushima nuclear plant accident revealed a prevalence of thyroid cancer of 37.3/100,000.…”

“…19 Lethal thyroid carcinomas usually occur in older adults but are very rare in comparison to the myriad harmless incidentalomas currently being diagnosed. Selective US follow-up of incidentalomas in elderly adults to assess for rapid growth has been considered.…”

We cannot ignore the real component of the rise in thyroid cancer incidence

“…Due to the young age group in the study by Bernier et al, as well as the overall excellent prognosis and protracted nature of thyroid cancer, mortality data unfortunately are unavailable. However, other large studies have shown that the pediatric population with differentiated thyroid cancer may present with more clinically extensive disease but their ultimate outcomes and survival are excellent …”