Carcinoma of the Thyroid in Children - A Review

Abstract

Thyroid cancer is the third most common solid tumor in children and adolescents. A review was made of the data on 540 such patients reported from nine large centers renowned for their experience with thyroid cancer. In respect to the pathogenesis the only factor conclusively known to promote development of thyroid cancer in the pediatric age group is irradiation, as documented by the Chernobyl experience. The evidence indicates that thyroid carcinoma in the pediatric age group is a biologically independent and more aggressive entity than in adults; paradoxically the prognosis is good. In the great majority of cases the only presenting sign was a neck mass. In a high percentage (60-80%) there were also palpable lymph nodes. The findings regarding lung metastases were not clear-cut: in most series they were present in about 10%, with a high of 28% in one group and a low of 5% in another group. Papillary carcinoma or the follicular variant of papillary carcinoma were the dominant histologic types, pure follicular carcinoma being found much less frequently than among adults with thyroid cancer. Despite the relatively advanced stage of the disease upon diagnosis, only 13 patients died of the disease, 12 to 33 years postoperatively. Recurrence rates ranged between 10% to 35%, with involvement of the lateral neck, thyroidal bed or distant sites 3 to 33 years after treatment; most failures responded to further surgery or radioactive iodine. There is almost general agreement that surgical intervention should consist of total or near total thyroidectomy despite the high rates of recurrent laryngeal nerve paralysis and hypocalcemia. In regard to neck metastases less than radical surgery has proved during the years to be sufficiently effective. Radioactive iodine, used by all at some stage of management for treatment purposes, should be used prophylactically only after due consideration in view of possible teratogenicity.

Thyroid carcinoma in children and adolescents. Presentation, clinical course, and outcome of therapy in 23 children and adolescents in Northern Greece

“…Some authors suggest that subtotal thyroidectomy and thyroid hormone suppressive therapy are effective in controlling disease restricted to one lobe. The majority of the authors, however, recommend total or near-total thyroidectomy, 22 selective lymph node dissection when neck metastases are present, ablation therapy with radioactive 131 I, and thyroid hormone suppressive therapy 23,24 In view of the fact that DTC are often bilateral and multifocal in origin, 4,17 we apply in our center total thyroidectomy as the treatment of choice. The reported high rate of lesions to the laryngeal nerve and postoperative hypoparathyroidism 4 were infrequent complications in our series and must be so in general if patients are referred to specialized surgeons.…”

A Radiation-Induced Gene Signature Distinguishes Post-Chernobyl from Sporadic Papillary Thyroid Cancers

“…Thyroid cancer is the third most common solid tumor in children and adolescents (1). Radiation exposure at a young age is known to cause thyroid cancer, predominantly of the papillary type (2,3).…”

Differentiated Thyroid Carcinoma That Express Sodium-Iodide Symporter Have a Lower Risk of Recurrence for Children and Adolescents

“…Furthermore, none of these studies included any significant numbers of children or adolescents. This latter omission is important, because several findings indicate that thyroid carcinoma of children and adolescents follow a more benign clinical course and may have a different pattern of growth factor and oncogene activation (27)(28)(29)(30)(31)(32). For these reasons, the current study was designed to examine NIS expression among benign and malignant thyroid tumors and to correlate NIS expression with the outcome of thyroid carcinoma in children and adolescents.…”

“…In addition, there are important clinical and molecular differences between thyroid cancers from children and adolescents compared with adults. First, thyroid cancers have a lower mortality rate but a higher recurrence rate in children and adolescents compared with adults (27)(28)(29)(30). Although late recurrence can be seen, the vast majority of tumors that ever recur (90%) do so within the first 7 y after treatment (29).…”