Carcinoma de tireóide na infância e adolescência

Abstract

RESUMOAproximadamente 10% das neoplasias de tireóide aparecem abaixo dos 21 anos e representam 3% das neoplasias da infância, com predomínio em meninas (2F:1M). São papilíferos em 90% casos e mais freqüentemente bilaterais, multifocais e de maior dimensão. Invasão de cápsula e metástases ganglionar ou pulmonar são mais freqüentes que no adulto. O efeito carcinogênico da radiação é especialmente importante na criança pré-púbere. Em 5% dos casos de PTC existe história familial. Genes como o RET/PTC, RAS e BRAF estão habitualmente envolvidos na gênese do processo. A apresentação clínica pode ser nódulo cervical (90% casos) sem que represente um fator de pior prognós-tico. O US e a PAAF são procedimentos diagnósticos valiosos. O tratamento deve ser cirúrgico (tireoidectomia total com esvaziamento ganglionar) seguido de PCI e radioterapia ablativa. A substituição com L-tiroxina deve objetivar a supressão crônica do TSH. O prognóstico ao longo prazo é melhor que no adulto. A quantificação da Tg plasmática também é útil na detecção da doença residual. Approximately 10% of thyroid cancers are present in patients less than 21 years of age, representing 3% of all cancers of children and adolescents, with predominance in females 2:1 in relation to males. Thyroid cancers in this age group are usually papillary (90%), bilateral, multifocal and bigger in size compared to adults. Capsule invasion and lymphatic and pulmonary metastases are more frequent in children. Radiation sensitivity seems to represent an important factor in prepubertal patients. Familial history is reported in 5% of the cases. Genes such as RET/PTC, RAS and BRAF are usually involved in thyroid carcinogenesis in this age group. Cervical adenomegaly is a common clinical presentation, but does not represent a poor prognostic factor in children. Ultrasound and fine needle aspiration biopsy are valuable diagnostic procedures. Surgery is the preferred treatment including thyroidectomy and ganglionary excision, followed by ablative radioiodine therapy. L-thyroxine replacement with suppressive dosage should be employed targeting chronic TSH suppression. Long-term prognosis is usually better in children when compared with adults. Plasma thyroglobulin measurement is also useful to detect residual thyroid cancer disease.

Intrathyroidal Thymic Tissue Surrounding an Intrathyroidal Parathyroid Gland, the Cause of a Solitary Thyroid Nodule in a 6-Year-Old Boy

“…Thyroid function tests are not helpful because children with solitary thyroid nodules are usually euthyroid (7). However, tumor markers (calcitonin or thyroglobulin) might be elevated in thyroid carcinoma and should therefore be investigated (17)(18)(19). The ultrasound of the thyroid gland provides important information to classify the underlying condition and should be the first diagnostic step (20) after a detailed physical examination of the patient.…”

Assistência à Saúde da Criança com Câncer na Produção Científica Brasileira

“…as questões prognósticas de morbi-mortalidade revelam os principais tipos de câncer que acometem a população pediátrica, sua prevalência, o quadro epidemiológico (sexo, idade, raça, entre outros), as taxas de cura, a estimativa de sobrevida e o quantitativo de óbitos 14 .…”

Choice of tube extremity for emission of the lowest radiation dose in pediatric patients

“…Monte et al showed that about 10% of neoplasms usually occur in people younger than 21 years old, which represents 3% of all childhood neoplasms. Thus, the carcinogenic effect of radiation is particularly concerning in prepubertal individuals [ 7 ]. Worldwide trends indicate that medical radiation exposure has been increasing, due to cardiological procedures, and particularly in cases involving CHD [ 5 ].…”