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
...roid Nodules...
...e evaluation and treatment of thyr...
...ositive mutational test appears highly likely t...
...patients with autoimmune thyroiditis, evaluatio...
...tment of Benign Nodules...
We are unable to recommend for or...
...ign lesions should be followed by seria...
...tric patients with a suppressed TSH as...
Differentiated Thyroid Cancer
...fferentiated Thyroid Cancer...
Diagnosi...
...annual physical exam is recommended in childr...
...ith a history of radiation exposure to th...
Patients at increased risk of developing f...
...NM Classification System should be used to describ...
...found to have disease confined to the thyr...
...emains unclear if younger chi...
...AJCC TNM Classification System for Differenti...
...A Pediatric Thyroid Cancer Risk Levels and...
...reatmen...
Children with DTC should be cared for b...
Surger...
...oid surgery, especially if compartment-fo...
...rehensive neck US to interrogate all regions of t...
...ority of children, total thyroidectomy i...
...ded for children with malignant cytol...
...ients with PTC and no clinical evidence of gross...
...artment-oriented resection is the r...
...udies to assess if TT with prophylactic CND diss...
...ical confirmation of metastatic disease to...
...iatric thyroid surgery should be perfo...
...e early incorporation of calcium and calc...
...rative staging is usually performe...
...itial Postoperative Staging for ATA Pediatric I...
... Treatment...
...ndicated for treatment of iodine-avid per...
...n order to facilitate 131I uptake by residual io...
...dequate hydration should be ensured in all childre...
...routine use of lithium and amifostine c...
...ck of data comparing empiric treatment and...
...ment WBS is recommended for all children...
...benefits and risks, both acute and chronic, fol...
...ment of the Pediatric Patient with Known...
...Management of the Pediatric Patient with Kn...
...rveillance And Follow...
...hildren with DTC may experience adverse psychoso...
...rence of DTC in children has been reported a...
...es as a sensitive tumor marker in the evaluation,...
...tectable TSH-stimulated Tg (with negative...
...low-level TSH-stimulated Tg...
...reasing or frankly elevated levels of TSH...
...g level cannot be interpreted in children...
...s recommended in the follow-up of children w...
During the follow up of children with PTC who...
...ld be performed in children with ATA Pediatr...
...negative DxWBS is obtained, there is no benefit...
For the child with a detectable TSH-suppre...
...ty of 18FDG-PET/CT is poorly studied in p...
...iric 131I therapy and a posttreatm...
...pression Therapy...
...H suppression in children with DTC sho...
...Recurrent Cervical Disease...
...n to treat or to observe structurally i...
...ren with macroscopic cervical disease (>1 cm in s...
...cervical disease (visualized with DxWBS)...
...gery is performed, postoperative re-sta...
...nary Metastases...
...hildren with RAI-avid pulmonary metastase...
...a therapeutic activity of 131I, the...
...e full clinical and biochemical (Tg) response...
...atment of RAI-avid pulmonary metastase...
...nt of pulmonary metastases with 131I is not reco...
...monary function testing should be cons...
...incidental PTC should be managed simi...
...t children with asymptomatic and non...
Follicular Thyroid Carcinoma
...r Thyroid Carcinoma...
...FTC is a rare malignancy. Because of the p...
...ly-invasive FTC...
...ll children diagnosed with FTC, consideration s...
Table 4. Hereditary Tumor Syndromes Associated with Thyroid Nodules/DTC
...tary Tumor Syndromes Associated wit...