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

...id Nodules...

...evaluation and treatment of thyroid nodul...

...positive mutational test appears hi...

...atients with autoimmune thyroiditis, evaluation by...


...nt of Benign Nodules...

...nable to recommend for or against the routi...

...enign lesions should be followed by ser...

...r pediatric patients with a suppre...


Differentiated Thyroid Cancer

...entiated Thyroid Cance...

...gnosis...

...ical exam is recommended in children at high risk...

...a history of radiation exposure to...

Patients at increased risk of developing f...

...Classification System should be used to d...

...nts found to have disease confined to the thyr...

...ns unclear if younger children...

...TNM Classification System for Diff...

...able 3. ATA Pediatric Thyroid Cancer Risk...


...eatment

...ildren with DTC should be cared for by team...

Surge...

...ediatric thyroid surgery, especially if...

...comprehensive neck US to interrogate all...

...ty of children, total thyroidectomy...

...recommended for children with malignant...

...nts with PTC and no clinical evidence of gros...

...t-oriented resection is the recommended...

...to assess if TT with prophylactic CN...

...l confirmation of metastatic disease to lymph node...

...roid surgery should be performed in a hospit...

...corporation of calcium and calcitriol in pat...

...ative staging is usually performed...

...2. Initial Postoperative Staging for AT...

...I Treatment

...indicated for treatment of iodine-avid persiste...

...n order to facilitate 131I uptake by residual iodi...

...ate hydration should be ensured in a...

...ine use of lithium and amifostine cannot be...

...the lack of data comparing empiric...

...reatment WBS is recommended for all children 4-7...

...are clear benefits and risks, both...

...igure 3. Management of the Pediatric Pa...

...e 4. Management of the Pediatric Pa...

Surveillance And Follo...

...DTC may experience adverse psychosocial effects an...

...nce of DTC in children has been reported as l...

...sensitive tumor marker in the evaluation, treat...

...table TSH-stimulated Tg (with negat...

...a low-level TSH-stimulated Tg...

...frankly elevated levels of TSH-sti...

...Tg level cannot be interpreted in children with...

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

...llow up of children with PTC who are suspected t...

...be performed in children with ATA P...

...e a negative DxWBS is obtained, there i...

...r the child with a detectable TSH-suppre...

...8FDG-PET/CT is poorly studied in pediatric DTC, a...

...ric 131I therapy and a posttreatment scan are not...

...pression Therapy...

...in children with DTC should be deter...

...rsistent/Recurrent Cervical Di...

...n to treat or to observe structurally identifiabl...

...dren with macroscopic cervical disease (>1...

...vid cervical disease (visualized with...

...urgery is performed, postoperative re-s...

...ulmonary Metasta...

...with RAI-avid pulmonary metastases visualize...

...r a therapeutic activity of 131I, the TSH-s...

...full clinical and biochemical (Tg) response...

...eatment of RAI-avid pulmonary meta...

...treatment of pulmonary metastases w...

...unction testing should be considered in all child...

...ldren with incidental PTC should be manage...

...st children with asymptomatic and non-pr...


Follicular Thyroid Carcinoma

...ular Thyroid Carcinom...

...is a rare malignancy. Because of the...


...mally-invasive F...


...diagnosed with FTC, consideration should be...


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

.... Hereditary Tumor Syndromes Associated with Thy...