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
...oid Nodules...
Diagnosis...
...he evaluation and treatment of thyroid nodu...
...utational test appears highly likel...
...r patients with autoimmune thyroiditis, e...
...atment of Benign Nodules
...e to recommend for or against the routine use...
...ign lesions should be followed by serial U...
...r pediatric patients with a suppressed T...
Differentiated Thyroid Cancer
...tiated Thyroid Cancer...
Diagnosis
...n annual physical exam is recommended in...
...n with a history of radiation exposure to the th...
...ents at increased risk of developing familia...
...AJCC TNM Classification System should be used t...
...nts found to have disease confined to...
...unclear if younger children (...
...e 2. AJCC TNM Classification System for Differen...
...diatric Thyroid Cancer Risk Levels...
...eatmen...
...DTC should be cared for by teams of phys...
...urgery...
...id surgery, especially if compartment-foc...
A comprehensive neck US to interro...
...the majority of children, total thyroidecto...
...ed for children with malignant cytolo...
...patients with PTC and no clinical evidence of...
...iented resection is the recommended approach fo...
...to assess if TT with prophylactic...
...ogical confirmation of metastatic disease to lym...
...ric thyroid surgery should be performed...
...rporation of calcium and calcitriol in patients at...
...staging is usually performed within 1...
...Initial Postoperative Staging for ATA...
... Treatment
...indicated for treatment of iodine-av...
...order to facilitate 131I uptake by residual...
...ion should be ensured in all children receivi...
...e of lithium and amifostine cannot be rec...
...ed on the lack of data comparing empiric...
...ment WBS is recommended for all children 4-7 days...
...r benefits and risks, both acute and chron...
...gement of the Pediatric Patient with Known or S...
...ure 4. Management of the Pediatric Patient with...
...llance And Follow Up...
...ith DTC may experience adverse psychosocial e...
...DTC in children has been reported as long as 40 ye...
...s as a sensitive tumor marker in the evaluation, t...
...TSH-stimulated Tg (with negative TgAb) iden...
...f a low-level TSH-stimulated Tg
...frankly elevated levels of TSH-stimulat...
...g level cannot be interpreted in children with p...
...ecommended in the follow-up of chil...
...he follow up of children with PTC...
A DxWBS should be performed in children w...
...a negative DxWBS is obtained, there is n...
...child with a detectable TSH-suppressed...
...8FDG-PET/CT is poorly studied in pediat...
...31I therapy and a posttreatment scan ar...
...uppression Therapy...
...H suppression in children with DTC should...
...ecurrent Cervical Disease...
...sion to treat or to observe structurally id...
...with macroscopic cervical disease (>1 cm...
...cervical disease (visualized with DxWBS) coul...
...peat surgery is performed, postoperative re...
...monary Metasta...
...en with RAI-avid pulmonary metastases visualized w...
...r a therapeutic activity of 131I, the TSH...
...e full clinical and biochemical (Tg)...
...t of RAI-avid pulmonary metastases s...
...ent of pulmonary metastases with 131...
...on testing should be considered in all child...
...ren with incidental PTC should be man...
...en with asymptomatic and non-progressive 131I...
Follicular Thyroid Carcinoma
...ollicular Thyroid Carcinoma
...s a rare malignancy. Because of the paucity of...
...lly-invasive FTC...
...n all children diagnosed with FTC, consideration s...
Table 4. Hereditary Tumor Syndromes Associated with Thyroid Nodules/DTC
...ary Tumor Syndromes Associated with Thyroid Nodu...