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 Nodules
...evaluation and treatment of thyroid nodule...
...positive mutational test appears high...
...s with autoimmune thyroiditis, evaluation by...
...ent of Benign Nodules...
...ble to recommend for or against the routin...
...lesions should be followed by seria...
...atric patients with a suppressed TSH a...
Differentiated Thyroid Cancer
...entiated Thyroid Cancer...
...gnosis...
...l physical exam is recommended in chi...
...ren with a history of radiation exposure...
...t increased risk of developing familial DTC shoul...
...TNM Classification System should be...
...o have disease confined to the thyroid...
...ns unclear if younger children...
...TNM Classification System for Differentiated...
...e 3. ATA Pediatric Thyroid Cancer Risk...
...eatment...
...h DTC should be cared for by teams of physici...
...rgery...
...thyroid surgery, especially if compartment-fo...
...ive neck US to interrogate all regions of...
...rity of children, total thyroidectomy is recomme...
...D is recommended for children with mal...
For patients with PTC and no clinic...
...rtment-oriented resection is the reco...
...tudies to assess if TT with prophyl...
...cal confirmation of metastatic disease to lymp...
Pediatric thyroid surgery should b...
...incorporation of calcium and calcitriol in p...
...e staging is usually performed with...
...2. Initial Postoperative Staging for AT...
...I Treatment...
...cated for treatment of iodine-avid persistent loc...
...ilitate 131I uptake by residual iodine-avid can...
...hydration should be ensured in all...
...utine use of lithium and amifostine cannot be r...
...ck of data comparing empiric treatm...
...WBS is recommended for all children 4-7 days after...
...ear benefits and risks, both acute and chro...
Figure 3. Management of the Pediatric P...
...4. Management of the Pediatric Pa...
...rveillance And Foll...
...th DTC may experience adverse psychosocia...
...e of DTC in children has been reported as long as...
...s a sensitive tumor marker in the evaluation...
...able TSH-stimulated Tg (with negative...
...on of a low-level TSH-stimulated Tg
...frankly elevated levels of TSH-stim...
...l cannot be interpreted in children...
...recommended in the follow-up of children...
...uring the follow up of children with PTC who...
...should be performed in children with ATA P...
...DxWBS is obtained, there is no benefit from s...
...hild with a detectable TSH-suppressed T...
...lity of 18FDG-PET/CT is poorly studied in pediatr...
...c 131I therapy and a posttreatment scan...
...Suppression Ther...
...ppression in children with DTC shoul...
...sistent/Recurrent Cervical...
...ion to treat or to observe structurally i...
...en with macroscopic cervical disea...
...rvical disease (visualized with DxW...
...ry is performed, postoperative re-staging can be u...
...lmonary Metast...
...RAI-avid pulmonary metastases visualized with...
After a therapeutic activity of 131I...
...the full clinical and biochemical (Tg...
...of RAI-avid pulmonary metastases should be con...
...of pulmonary metastases with 131I is not r...
...nction testing should be considered in all...
...ren with incidental PTC should be managed...
...with asymptomatic and non-progressive 131I-refr...
Follicular Thyroid Carcinoma
Follicular Thyroid Carcinom...
...ic FTC is a rare malignancy. Because of the...
...inimally-invasiv...
...en diagnosed with FTC, consideration sh...
Table 4. Hereditary Tumor Syndromes Associated with Thyroid Nodules/DTC
...e 4. Hereditary Tumor Syndromes Associated...