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
...Thyroid Nodu...
...Diagnosis...
The evaluation and treatment of thyroi...
...ional test appears highly likely to be a...
...ith autoimmune thyroiditis, evaluation...
Tr...
...unable to recommend for or against the...
...lesions should be followed by serial...
...or pediatric patients with a suppressed...
Differentiated Thyroid Cancer
...Differenti...
D...
...cal exam is recommended in children...
...th a history of radiation exposure to...
...t increased risk of developing familial DTC s...
...Classification System should be used to describe...
Patients found to have disease confi...
...emains unclear if younger children (
...TNM Classification System for Differentiat...
...A Pediatric Thyroid Cancer Risk Levels...
...T...
...with DTC should be cared for by teams of physicia...
...Surge...
...c thyroid surgery, especially if compartment-fo...
...rehensive neck US to interrogate all regions of th...
...y of children, total thyroidectomy is recommended...
...mmended for children with malignant cytol...
...s with PTC and no clinical evidence o...
...oriented resection is the recommended appro...
...to assess if TT with prophylactic CND...
...ytological confirmation of metastatic di...
...ediatric thyroid surgery should be performed in...
...arly incorporation of calcium and calcitr...
...staging is usually performed within 12 wee...
...igure 2. Initial Postoperative Staging for ATA Ped...
...131I T...
...indicated for treatment of iodine-avid persist...
...order to facilitate 131I uptake by resid...
Adequate hydration should be ensured in all c...
...of lithium and amifostine cannot be...
...d on the lack of data comparing emp...
...reatment WBS is recommended for all...
...benefits and risks, both acute and...
...3. Management of the Pediatric Patient...
...anagement of the Pediatric Patient w...
...Surveillance A...
Children with DTC may experience adverse psycho...
...DTC in children has been reported as long...
...es as a sensitive tumor marker in the evalu...
...ectable TSH-stimulated Tg (with negative TgAb...
...of a low-level TSH-stimulated Tg...
...frankly elevated levels of TSH-stimulated Tg (>...
...nnot be interpreted in children wi...
...is recommended in the follow-up of chil...
...ring the follow up of children with PTC who are...
...hould be performed in children with...
...gative DxWBS is obtained, there is no...
...ld with a detectable TSH-suppressed Tg but a nega...
...utility of 18FDG-PET/CT is poorly studied in pedi...
...I therapy and a posttreatment scan...
...TSH Suppression Therap...
...H suppression in children with DTC should be...
...Persistent/...
The decision to treat or to observe s...
...hildren with macroscopic cervical diseas...
...cervical disease (visualized with DxWBS) coul...
...urgery is performed, postoperative re-sta...
...Pulmonary Meta...
...n with RAI-avid pulmonary metastases visualized...
...er a therapeutic activity of 131I, the TS...
...f the full clinical and biochemical...
...nt of RAI-avid pulmonary metastases should b...
...t of pulmonary metastases with 131...
...ary function testing should be consi...
...with incidental PTC should be managed s...
...dren with asymptomatic and non-progressive...
Follicular Thyroid Carcinoma
...Follicular Thyro...
...is a rare malignancy. Because of the pauc...
...inimally-invasive F...
...n diagnosed with FTC, consideration should...
Table 4. Hereditary Tumor Syndromes Associated with Thyroid Nodules/DTC
...Hereditary Tumor Syndromes Associat...