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Review
. 2011 Dec;32(6):798-826.
doi: 10.1210/er.2011-0011. Epub 2011 Aug 31.

The treatment of differentiated thyroid cancer in children: emphasis on surgical approach and radioactive iodine therapy

Scott A Rivkees  1 , Ernest L Mazzaferri, Frederik A Verburg, Christoph Reiners, Markus Luster, Christopher K Breuer, Catherine A Dinauer, Robert Udelsman
Affiliations
Review

The treatment of differentiated thyroid cancer in children: emphasis on surgical approach and radioactive iodine therapy

Scott A Rivkees et al. Endocr Rev. 2011 Dec.

Abstract

Pediatric thyroid cancer is a rare disease with an excellent prognosis. Compared with adults, epithelial-derived differentiated thyroid cancer (DTC), which includes papillary and follicular thyroid cancer, presents at more advanced stages in children and is associated with higher rates of recurrence. Because of its uncommon occurrence, randomized trials have not been applied to test best-care options in children. Even in adults that have a 10-fold or higher incidence of thyroid cancer than children, few prospective trials have been executed to compare treatment approaches. We recognize that treatment recommendations have changed over the past few decades and will continue to do so. Respecting the aggressiveness of pediatric thyroid cancer, high recurrence rates, and the problems associated with decades of long-term follow-up, a premium should be placed on treatments that minimize risk of recurrence and the adverse effects of treatments and facilitate follow-up. We recommend that total thyroidectomy and central compartment lymph node dissection is the surgical procedure of choice for children with DTC if it can be performed by a high-volume thyroid surgeon. We recommend radioactive iodine therapy for remnant ablation or residual disease for most children with DTC. We recommend long-term follow-up because disease can recur decades after initial diagnosis and therapy. Considering the complexity of DTC management and the potential complications associated with therapy, it is essential that pediatric DTC be managed by physicians with expertise in this area.

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Figures

Fig. 1.
Fig. 1.
The changing incidence of thyroid cancer as related to age. [Derived from (4).]
Fig. 2.
Fig. 2.
The 5-, 15-, and 30-yr survival rates for papillary, follicular, and medullary thyroid carcinoma in children. *, P = 0.006. [Derived from (1).]
Fig. 3.
Fig. 3.
Outcome event by age (percentage). The left box shows the group with high risk for recurrence, and the right box shows the group with high risk for mortality. [Derived from (127).]
Fig. 4.
Fig. 4.
Disease-free survival at 10 yr after initial therapy in children treated with or without 131I in studies where data for the two different groups are presented. Numbers of children in each group and administered activities are shown. Note that patients were not randomized to be treated or not treated in these studies, and there was a bias toward treating patients with more extensive disease.
Fig. 5.
Fig. 5.
Algorithm for the evaluation and treatment of DTC in children. US, Ultrasound.
Fig. 6.
Fig. 6.
Algorithm for the follow-up of DTC in children. US, Ultrasound; LT4, levothyroxine.
See this image and copyright information in PMC

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