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
...hyroid Nodules
...nosis...
The evaluation and treatment of thyroid nodules...
...mutational test appears highly likely to...
...s with autoimmune thyroiditis, evaluation b...
...eatment of Benign Nodules...
...re unable to recommend for or against the rout...
...should be followed by serial US (see Figure...
...c patients with a suppressed TSH associated with...
Differentiated Thyroid Cancer
...entiated Thyroid Cancer...
...agnosis...
...physical exam is recommended in children at high...
...hildren with a history of radiation...
...reased risk of developing familial DTC should...
...JCC TNM Classification System shou...
...o have disease confined to the thyroid gland, as w...
...ns unclear if younger children (
...e 2. AJCC TNM Classification System for D...
...diatric Thyroid Cancer Risk Levels and Postoperat...
...eatment...
...DTC should be cared for by teams of phy...
Surge...
...tric thyroid surgery, especially if compartme...
...mprehensive neck US to interrogate all...
...ority of children, total thyroidectomy is recomme...
...recommended for children with malignant cyto...
For patients with PTC and no clinical evidence o...
...-oriented resection is the recommended a...
...o assess if TT with prophylactic C...
...onfirmation of metastatic disease to...
...ediatric thyroid surgery should be performe...
...corporation of calcium and calcitrio...
...rative staging is usually performed within 12 week...
...Initial Postoperative Staging for ATA Pediatri...
...31I Treatm...
...ted for treatment of iodine-avid pe...
...n order to facilitate 131I uptake by...
...ion should be ensured in all children receiving...
...outine use of lithium and amifostin...
...ck of data comparing empiric treatment and tre...
...ent WBS is recommended for all children 4-7 day...
There are clear benefits and risks, both acut...
.... Management of the Pediatric Patient with Known o...
...ement of the Pediatric Patient with Know...
...llance And Follow Up...
...DTC may experience adverse psychosocial effects an...
...C in children has been reported as lo...
...as a sensitive tumor marker in the evaluation...
...le TSH-stimulated Tg (with negative Tg...
...ction of a low-level TSH-stim...
...g or frankly elevated levels of TSH-stimulated Tg...
...l cannot be interpreted in children with positi...
...US is recommended in the follow-up of children w...
...w up of children with PTC who are su...
...ld be performed in children with ATA Pediatric...
...ive DxWBS is obtained, there is no b...
...ld with a detectable TSH-suppressed Tg but...
...18FDG-PET/CT is poorly studied in pediatric DTC...
...iric 131I therapy and a posttreatment scan...
TSH Suppression Ther...
...ession in children with DTC should be determined...
...tent/Recurrent Cervical Diseas...
...to treat or to observe structurally identifiable...
...with macroscopic cervical disease (...
...-avid cervical disease (visualized w...
...repeat surgery is performed, posto...
...nary Metastases...
...ldren with RAI-avid pulmonary metastases visua...
...apeutic activity of 131I, the TSH-sup...
...l clinical and biochemical (Tg) respo...
...RAI-avid pulmonary metastases should be consider...
...pulmonary metastases with 131I is not...
...monary function testing should be considered...
...n with incidental PTC should be managed si...
...en with asymptomatic and non-progress...
Follicular Thyroid Carcinoma
...llicular Thyroid Carcinoma
...c FTC is a rare malignancy. Because...
Minimally-invasive FTC
...hildren diagnosed with FTC, consideration shou...
Table 4. Hereditary Tumor Syndromes Associated with Thyroid Nodules/DTC
...le 4. Hereditary Tumor Syndromes Ass...