Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer

Abstract

Background: Previous guidelines for the management of thyroid nodules and cancers were geared toward adults. Compared with thyroid neoplasms in adults, however, those in the pediatric population exhibit differences in pathophysiology, clinical presentation, and long-term outcomes. 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 overly aggressive treatment. For these reasons, unique guidelines for children and adolescents with thyroid tumors are needed. Methods: A task force commissioned by the American Thyroid Association (ATA) developed a series of clinically relevant questions pertaining to the management of children with thyroid nodules and differentiated thyroid cancer (DTC). Using an extensive literature search, primarily focused on studies that included subjects £ 18 years of age, the task force identified and reviewed relevant articles through April 2014. Recommendations were made based upon scientific evidence and expert opinion and were graded using a modified schema from the United States Preventive Services Task Force. Results: These inaugural guidelines provide recommendations for the evaluation and management of thyroid nodules in children and adolescents, including the role and interpretation of ultrasound, fine-needle aspiration cytology, and the management of benign nodules. Recommendations for the evaluation, treatment, and follow-up of children and adolescents with DTC are outlined and include preoperative staging, surgical management, postoperative staging, the role of radioactive iodine therapy, and goals for thyrotropin suppression. Management algorithms are proposed and separate recommendations for papillary and follicular thyroid cancers are provided.

PTEN, DICER1, FH, and Their Associated Tumor Susceptibility Syndromes: Clinical Features, Genetics, and Surveillance Recommendations in Childhood

“…If normal, repeating every 3 years is justified by the risk for thyroid cancer, which is generally indolent but is curative with surgery alone when found in its earliest form. If nodules are seen, routine follow-up per standard pediatric endocrinology guidelines is recommended (23,29).…”

Marine-Lenhart syndrome in two adolescents, including one with thyroid cancer: a case series and review of the literature

“…Again, RAI should be avoided in children with a solitary hot nodule due to a higher intranodular cancer risk, as well as an increased risk of developing secondary cancers from low-level whole body radiation exposure [44]. Consequently, preoperative FNAC is usually not warranted to rule out thyroid cancer in children with hot nodules (and subsequently in children with Marine-Lenhart syndrome) unless surgery is deferred because the patient is either asymptomatic or has subclinical hyperthyroidism [45]. Conversely, preoperative confirmation of nodular cancer may guide the clinician to evaluate and prepare for the possibility of extrathyroid extension and/or regional neck metastasis.…”

Key Developments in Pediatric Endocrinology in 2015

“…7 The Task Force recognized that significant differences exist between children and adults. While the incidence of thyroid nodules is lower in children, the percentage of nodules harboring cancer is higher compared to adults.…”