Pediatric Thyroid Nodules and Differentiated Cancer
Key Points
Key Points
Compared with adults, thyroid neoplasms in the pediatric population exhibit differences in pathophysiology, clinical presentation, and long-term outcomes.
The most common presentation for DTC in children is that of a thyroid nodule. However, papillary thyroid cancer (PTC) also frequently presents as cervical adenopathy with or without a palpable thyroid lesion or as an incidental finding after imaging or surgery for an unrelated condition. Occasionally, the diagnosis is made only after the discovery of distant metastases.
- PTC accounts for 90% or more of all childhood cases. Follicular thyroid cancer (FTC) is uncommon while medullary thyroid cancer (MTC), poorly differentiated tumors and frankly undifferentiated (anaplastic) thyroid carcinomas are rare in young patients.
Furthermore, therapy that may be recommended for an adult may not be appropriate for a child who is at low risk for death but at higher risk for long-term harm from over-aggressive treatment.
Thyroid Nodules
...yroid Nodul...
...is
...evaluation and treatment of thyroid nodu...
...tational test appears highly likely to b...
...s with autoimmune thyroiditis, evaluat...
...ent of Benign Nodules...
...ble to recommend for or against the...
...n lesions should be followed by serial US...
...ric patients with a suppressed TSH assoc...
Differentiated Thyroid Cancer
Differentiated Thyroid...
...gnosis...
...al exam is recommended in children a...
...children with a history of radiation exposure to...
...at increased risk of developing fam...
...AJCC TNM Classification System should be us...
...ts found to have disease confined t...
...emains unclear if younger ch...
...TNM Classification System for Differ...
...ediatric Thyroid Cancer Risk Level...
...atment
...ildren with DTC should be cared for by te...
Surger...
...iatric thyroid surgery, especially if co...
...ehensive neck US to interrogate all r...
...the majority of children, total th...
...mmended for children with malignant cyt...
...tients with PTC and no clinical evidence o...
...nted resection is the recommended...
...s to assess if TT with prophylactic CND dissecti...
...firmation of metastatic disease to lymph no...
...thyroid surgery should be performed in a hosp...
...ly incorporation of calcium and calcitriol in pati...
...taging is usually performed within...
...nitial Postoperative Staging for ATA Pedia...
... Treatment...
...I is indicated for treatment of iod...
...rder to facilitate 131I uptake by residual iodine-...
...ration should be ensured in all children rece...
...ine use of lithium and amifostine cannot...
Based on the lack of data comparing empiric treat...
...posttreatment WBS is recommended for...
...clear benefits and risks, both acute...
...agement of the Pediatric Patient with Known or Sus...
...ment of the Pediatric Patient with Kno...
...eillance And Follow Up...
...DTC may experience adverse psychosocia...
...of DTC in children has been reported a...
...ves as a sensitive tumor marker in the eva...
...undetectable TSH-stimulated Tg (with negative Tg...
...of a low-level TSH-stimulated T...
...sing or frankly elevated levels of T...
...e Tg level cannot be interpreted in chil...
...ck US is recommended in the follow-u...
...follow up of children with PTC who are susp...
A DxWBS should be performed in children...
...ative DxWBS is obtained, there is no be...
...the child with a detectable TSH-suppress...
...18FDG-PET/CT is poorly studied in ped...
Empiric 131I therapy and a posttreatment s...
...uppression Therapy...
...on in children with DTC should be determined by...
...tent/Recurrent Cervical Disease...
...treat or to observe structurally i...
...ldren with macroscopic cervical disea...
...-avid cervical disease (visualized with DxW...
...rgery is performed, postoperative r...
...ulmonary Metas...
...ith RAI-avid pulmonary metastases visualiz...
...tic activity of 131I, the TSH-suppr...
...he full clinical and biochemical (Tg) response s...
...RAI-avid pulmonary metastases should be conside...
...pulmonary metastases with 131I is no...
...lmonary function testing should be considered...
...incidental PTC should be managed similar...
...ildren with asymptomatic and non-progressi...
Follicular Thyroid Carcinoma
...ular Thyroid Carcinom...
...TC is a rare malignancy. Because of the paucity...
Minimally-invasive...
...hildren diagnosed with FTC, consideration sho...
Table 4. Hereditary Tumor Syndromes Associated with Thyroid Nodules/DTC
...ary Tumor Syndromes Associated with Thyro...