Pediatric Thyroid Nodules and Differentiated Cancer

Publication Date: July 10, 2015

Key Points

Key Points

According to the Surveillance, Epidemiology and End Results (SEER) program, new cases of thyroid cancer in people < age 20 represent 1.8% of all thyroid malignancies diagnosed in the United States. The incidence appears to be increasing.

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.

The pediatric age should be limited to a patient ≤18 years of age. Establishing a uniform upper limit of age will afford an opportunity to better define the potential impact of growth on tumor behavior. From a pragmatic point of view, individual centers may transition pediatric patients to adult care anywhere between 18 and 21 years of age. Clinicians may manage the "child" under these guidelines until transition has been completed. ( C )
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Thyroid Nodules

Thyroid No...

...e evaluation and treatment of thyroid nodules...

...ve mutational test appears highly likely to be as...

...atients with autoimmune thyroiditis, evaluatio...


...t of Benign Nodules...

...re unable to recommend for or against the routin...

...sions should be followed by serial US (see Fig...

...or pediatric patients with a suppressed TSH ass...


Differentiated Thyroid Cancer

...erentiated Thyroid Cance...

Diagnos...

...physical exam is recommended in chi...

...with a history of radiation expos...

...atients at increased risk of devel...

...NM Classification System should be used...

...found to have disease confined to the thyroid g...

...remains unclear if younger child...

...le 2. AJCC TNM Classification System for Differ...

...e 3. ATA Pediatric Thyroid Cancer Ri...


...atment...

...with DTC should be cared for by teams...

Surger...

...oid surgery, especially if compartment...

...ehensive neck US to interrogate all regions of the...

...or the majority of children, total thyroide...

...commended for children with malignant c...

...with PTC and no clinical evidence of gross extra...

...riented resection is the recommende...

...ies to assess if TT with prophylactic...

...onfirmation of metastatic disease to l...

...ic thyroid surgery should be performed in a hospit...

...corporation of calcium and calcitriol in pati...

...ostoperative staging is usually perf...

...l Postoperative Staging for ATA Pediatric Inter...

...1I Treatment...

...dicated for treatment of iodine-avid per...

...to facilitate 131I uptake by resid...

...ydration should be ensured in all c...

...utine use of lithium and amifostine cannot b...

...lack of data comparing empiric treat...

...ttreatment WBS is recommended for all c...

...e clear benefits and risks, both acute...

...nagement of the Pediatric Patient with Kn...

...agement of the Pediatric Patient with...

...veillance And Follow...

...with DTC may experience adverse psychosocial ef...

...DTC in children has been reported as...

...erves as a sensitive tumor marker in the evaluati...

...n undetectable TSH-stimulated Tg (with ne...

...on of a low-level TSH-stimula...

...frankly elevated levels of TSH-stimulat...

...g level cannot be interpreted in children wit...

...k US is recommended in the follow-up of...

...w up of children with PTC who are suspec...

...DxWBS should be performed in childre...

...ce a negative DxWBS is obtained, there...

...the child with a detectable TSH-suppr...

...e utility of 18FDG-PET/CT is poorly studied...

Empiric 131I therapy and a posttreatment sca...

...Suppression Therapy...

...ppression in children with DTC should be determine...

...sistent/Recurrent Cervica...

...decision to treat or to observe structurally ide...

...with macroscopic cervical disease (>...

...ical disease (visualized with DxWB...

...surgery is performed, postoperative re-...

...ulmonary Metastas...

...ildren with RAI-avid pulmonary metast...

...fter a therapeutic activity of 131I, the TSH-sup...

...f the full clinical and biochemical (Tg) respons...

Re-treatment of RAI-avid pulmonary metastases s...

...ent of pulmonary metastases with 131...

...lmonary function testing should be consid...

...h incidental PTC should be managed similarly to o...

...ith asymptomatic and non-progressive 13...


Follicular Thyroid Carcinoma

...ollicular Thyroid Carc...

...ic FTC is a rare malignancy. Because of the p...


Minimally-invasive...


...n all children diagnosed with FTC, con...


Table 4. Hereditary Tumor Syndromes Associated with Thyroid Nodules/DTC

.... Hereditary Tumor Syndromes Associated with Thyro...