Differentiated Thyroid Cancer: Determinants of Disease Progression in Patients <21 Years of Age at Diagnosis

Abstract

The progression-free survival rate was better after a complete resection and in older patients. Progression-free survival rate was the same after lobectomy or more extensive thyroid procedures, but comparison was confounded by the increased use of total or subtotal thyroidectomy in patients with advanced disease. The risk of permanent hypocalcemia increased when total or subtotal thyroidectomy was done. Thyroid lobectomy alone may be appropriate for patients with small localized lesions while total or subtotal thyroidectomy should be considered for more extensive tumors.

Treatment Approach, Surveillance, and Outcome of Well-Differentiated Thyroid Cancer in Childhood and Adolescence

“…No patients died of thyroid cancer. Previous studies, including prior data from our institution, have demonstrated worse PFS in younger patients, those with positive margins, and patients with more advanced disease (5,6). Extent of disease, age, sex, and positive margins had no significant effect on PFS.…”

“…Surgical removal of the thyroid is performed on nearly all patients, however, cervical lymphadenectomy and postoperative treatment with 131 I are variably used (4)(5)(6)(7). Posttreatment surveillance guidelines are not standardized, although it is known that these patients are at risk of recurrence for decades after diagnosis.…”

Carcinoma de tireóide em crianças e adolescentes - revisão de seis casos

“…As outras foram submetidas a biópsia excisional. A histologia mostrou um total de quatro carcinomas papilíferos e dois carcinomas foliculares; esta maior incidência de carcinoma papilífero também é registrada por outros autores [1][2][3][4][7][8][9] .…”

“…Defensores da tireoidectomia total justificam este procedimento com a alta incidência de doença multifocal, sendo encontrado em 40% dos casos 8 . Estudos mostram melhor evolução após ressecção completa e em pacientes mais velhos 9 , havendo até 60% de recidiva em menores de 7 anos, contra 27% em maiores 8 . As seis pacientes estudadas foram submetidas a tireoidectomia total, sem nenhuma complicação pós-operatória, seguida de reposição hormonal com tiroxina para manter TSH entre 0,05 e 0,1mcU/ml.…”

“…Nossa casuística, com seguimento de até 17 anos, constatou o bom prognóstico do carcinoma tireoidiano, sem registro de óbito, o que está de acordo com dados da literatura, que cita baixa taxa de mortalidade [1][2][3][4][8][9][10][11] . Todas as pacientes estão bem controladas, cinco delas sem sinais de doença ativa e uma com metástase pulmonar estável, como descrito acima.…”