Primary thyroid carcinoma in children: A retrospective study of 20 patients

Abstract

A total of 20 children (median age 11 years) were treated for primary thyroid carcinoma from 1976 to 1990. Papillary adenocarcinoma was diagnosed in 19 and follicular in one case. Nineteen of 20 patients were considered amenable to surgery, which consisted of total thyroidectomy in 14 and partial thyroidectomy in 5. Only one patient with extensive perithyroid soft tissue infiltration was treated with external beam radiotherapy. Monolateral or bilateral cervical nodal dissection was performed in eight and six children, respectively; in nine cases without clinical evidence of metastatic nodes. Pathological examination showed that tumor extent was greater than that clinically assessed: Multiple tumor foci within the thyroid were assessed in 8/19, unilateral positive nodes in 8, and bilateral in 6, and soft tissue infiltration in 7. Subsequently 10 patients received thyroid-stimulating hormone (TSH) suppressive hormonotherapy. Relapses occurred in 7/20 at 2-48 months (median 18) from primary treatment: Four in cervical nodes, two in cervical nodes and lungs, and one in lungs. These seven patients were salvaged with node dissection and radioiodine therapy for lung metastases. All the 20 children are alive and disease-free after a median follow-up of longer than 10 years. The incidence of relapse was greater in the group of patients not given TSH-suppressive hormonotherapy. Total thyroidectomy produced permanent hypoparathyroidism in 5/14 (36%). Thyroid carcinoma in children of this series frequently presented with multiple tumor foci within the thyroid and cervical node metastases. Prognosis was favourable even after relapse and was not related to the extent of surgical treatment. Limited surgery and suppressive hormonotherapy may be adequate therapy for thyroid carcinoma in children.

Childhood thyroid cancer in Belarus, Russia, and Ukraine after Chernobyl and at present

“…Since the prognosis in childhood patients with well-differentiated thyroid cancer is excellent in most cases, extent of removal has been a matter of debate for many years. Clinicians generally consider lumpectomy insufficient but hitherto there is no valid evidence that survival rates are significantly different in individuals undergoing primary total thyroidectomy or lesser extracapsular resections (52,56). The rationale for organ preserving surgery is a very low operative morbidity and good condition of patients after partial thyroidectomy at follow-up.…”

Thyroid carcinoma in children and adolescents. Presentation, clinical course, and outcome of therapy in 23 children and adolescents in Northern Greece

“…Some authors suggest that subtotal thyroidectomy and thyroid hormone suppressive therapy are effective in controlling disease restricted to one lobe. The majority of the authors, however, recommend total or near-total thyroidectomy, 22 selective lymph node dissection when neck metastases are present, ablation therapy with radioactive 131 I, and thyroid hormone suppressive therapy 23,24 In view of the fact that DTC are often bilateral and multifocal in origin, 4,17 we apply in our center total thyroidectomy as the treatment of choice. The reported high rate of lesions to the laryngeal nerve and postoperative hypoparathyroidism 4 were infrequent complications in our series and must be so in general if patients are referred to specialized surgeons.…”

“…Although pediatric patients with thyroid carcinoma tend to present with disease at a more advanced stage than adults, namely a higher incidence of lymph nodes and pulmonary metastases, the prognosis is better for them. 4,5 Guidelines with regards to optimal management of DTC in children and adolescents are based primarily on the experience of a few specialists of tertiary care academic Institutions. 6 Hence the description of additional cohorts of pediatric DTC patients is of intrinsic value.…”

Thyroid carcinoma in children and adolescents - review of six cases

“…As outras foram submetidas a biópsia excisional. A histologia mostrou um total de quatro carcinomas papilíferos e dois carcinomas foliculares; esta maior incidência de carcinoma papilífero também é registrada por outros autores [1][2][3][4][7][8][9] .…”

“…A tireoidectomia total é o procedimento de escolha para tumores malignos de tireóide, apesar da alta taxa de lesão de nervo laríngeo recorrente e do hipoparatireoidismo, este último sendo encontrado em 7 a 27% dos casos 8 . Em pacientes com carcinoma papilífero, sem invasão tumoral, metástases ou história de exposição a radiação nas primeiras 3 décadas de vida, alguns cirurgiões preferem excisão do lobo afetado, istmo e linfonodos adjacentes.…”