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 Nodule...
Diagnosis...
...he evaluation and treatment of thyroid...
...ive mutational test appears highly likely to be...
...atients with autoimmune thyroiditis, evaluatio...
...eatment of Benign Nodul...
...able to recommend for or against th...
...nign lesions should be followed by serial US (see...
...r pediatric patients with a suppressed TSH asso...
Differentiated Thyroid Cancer
...ferentiated Thyroid Cancer...
...gnosis...
...cal exam is recommended in children at high risk f...
...ith a history of radiation exposure to the t...
...creased risk of developing familial DTC...
The AJCC TNM Classification System shoul...
...ound to have disease confined to the thyroid gl...
...remains unclear if younger chi...
...2. AJCC TNM Classification System for Differentiat...
...Pediatric Thyroid Cancer Risk Levels and Postop...
...reatme...
...with DTC should be cared for by teams of...
...urgery...
...atric thyroid surgery, especially if compartment-f...
...comprehensive neck US to interrogate all regions...
...r the majority of children, total thyroidectomy i...
...commended for children with malignant cytology and...
...h PTC and no clinical evidence of gross extrat...
...tment-oriented resection is the recommende...
...studies to assess if TT with prophylact...
Cytological confirmation of metastatic disease...
...id surgery should be performed in...
...poration of calcium and calcitriol in pati...
...e staging is usually performed wit...
...ial Postoperative Staging for ATA Pediatr...
131I Treatmen...
...dicated for treatment of iodine-avid persistent...
...der to facilitate 131I uptake by residua...
...quate hydration should be ensured in all children...
...e of lithium and amifostine cannot be recom...
...e lack of data comparing empiric treat...
...WBS is recommended for all children 4-7 days af...
...benefits and risks, both acute and chronic, fo...
...3. Management of the Pediatric Patient wit...
...Management of the Pediatric Patient with Known Dis...
...lance And Follow Up...
...th DTC may experience adverse psychosocial effe...
...DTC in children has been reported as l...
Tg serves as a sensitive tumor marker in the...
...etectable TSH-stimulated Tg (with negati...
...ion of a low-level TSH-stimulated Tg...
Increasing or frankly elevated levels of...
...l cannot be interpreted in children with positive...
...is recommended in the follow-up of chil...
During the follow up of children with PTC wh...
...WBS should be performed in children wi...
Once a negative DxWBS is obtained, th...
...ith a detectable TSH-suppressed Tg but...
...utility of 18FDG-PET/CT is poorly studied in ped...
...ic 131I therapy and a posttreatment scan are not...
TSH Suppression The...
...ppression in children with DTC should be...
...Recurrent Cervical Disease...
...he decision to treat or to observe structur...
...en with macroscopic cervical disease (>1 cm in siz...
...d cervical disease (visualized with...
...epeat surgery is performed, postope...
...lmonary Metastases
...hildren with RAI-avid pulmonary metastases...
...therapeutic activity of 131I, the TSH-suppre...
...nical and biochemical (Tg) response suggests pers...
...-treatment of RAI-avid pulmonary metastases...
...ent of pulmonary metastases with 131I is not recom...
...ry function testing should be considered in...
...incidental PTC should be managed similarly t...
...children with asymptomatic and non-progressive...
Follicular Thyroid Carcinoma
Follicular Thyroid C...
...ic FTC is a rare malignancy. Because...
...nimally-invasive FTC...
...diagnosed with FTC, consideration sho...
Table 4. Hereditary Tumor Syndromes Associated with Thyroid Nodules/DTC
...tary Tumor Syndromes Associated with Thyroid No...