THE PEDIATRIC PAPILLARY THYROID CANCER

Trang 1 THE PEDIATRIC PAPILLARY THYROIDCANCER Trang 2 IN GENERALPediatric thyroid cancer is a rare and treatable disease with an excellent prognosis, Papillary thyroid cancer PTC accoun

THE PEDIATRIC PAPILLARY THYROID

CANCER

BS Nguyễn Tuấn Cường

MEDIC

IN GENERAL

Pediatric thyroid cancer is a rare and treatable disease with an excellent prognosis, Papillary thyroid cancer (PTC) accounts for the vast majority

of cases

In children: <10 years of age, the incidence: 1 per 1,000,000 From 10 to

14, the incidence: 1 per 200,000

IN GENERAL

Compared with adults, children with PTC present with more extensive

disease, at more advanced stages and is associated with higher rates of recurrence, yet mortality rates are low

Lymph node involvement: 40–90% of children, compared with 20–50% of adults

The prevalence of distant metastases, most commonly lung, is 15–30% in children vs 2% in adults

Multifocal disease is more common in children than adults: about 40% Fortunately, even in the presence of metastatic disease, long-term

follow-up data show 30-year survival rates of 90–99% for children

CASE 1

MALE, 11YS DETECTED GOITER ON THE LEFT FOR 1 WEEK

CASE 1

CASE 2

FEMALE, 14 YS DETECTED GOITER FOR 10 DS

CASE 2: OPERATED ON 24/01/2024

Risk Factors for Thyroid Cancer in Children:

Head and neck irradiation The incidence of DTC increases linearly with

radiation doses up to 30 Gy, (3,000 cGy or Rad) and declines with higher doses

Thyroid cancer in children can also be observed in families: A calcitonin level may be measured to screen for medullary thyroid cancer, which accounts for 3–5% of pediatric thyroid cancers

ULTRASOUND + FNAC

The predictive value of the Bethesda system for pediatric thyroid nodules: the risk of malignancy may be higher in children than adults when cytology

is Bethesda criteria III or IV

1 Total thyroidectomy and central compartment lymph node dissection are the surgical procedure of choice for DTC

2 RAI is favored in children with DTC and lymph node involvement:

+ should be assumed to have micrometastases

+ to ablate residual disease and reduce the risk of disease recurrence

+ 1.5–3 mCi/kg, distant metastases and recurrent disease: up to 5 mCi/kg + TSH levels >30 mU/L appear to be adequate to stimulate 131I uptake in thyroid remnants and functional metastatic lesions:

T4 medication should be discontinued 2–3 weeks before RAI

low-iodine diet: 2ws

water-soluble intravenous contrast agents: 4ws

+ Evidence also suggests that relatively high doses of 131I may contribute to

an increased risk of SPMs (secondary primary malignancies)

3 Levothyroxine Therapy: standard practice, TSH suppression can reduce rates of recurrence TSH levels should be maintained:

<0.1 mU/L: extensive lateral nodal or distant metastatic disease

0.1–0.5 mU/L: intermediate risk or recurrence

0.5–1.0 mU/L: minimal or no lymph node involvement

+ be relaxed after several years of follow-up with no evidence of disease progression or recurrence: most recurrent DTC develops within 5 years after initial treatment

+ Ultrasound and TSH-suppressed Tg level assessment is recommended every 3–6 months

+ Ultrasound: not only focus on the thyroid bed, but encompass the neck in full, examining each lymph node compartment

Children commonly have infection-related lymphadenopathy

FNAC: persistent or enlarging lymph nodes or lymph nodes with abnormal characteristics: loss of hilum, a round rather than oval shape, and/or

calcification

Tg levels should be assessed in lymph node aspirates

+ at select times, whole-body radioiodine scans:

based on concern for persistent or recurrent disease using US and/or Tg results especially useful in the detection of lung metastases that are not apparent by chest radiographs or CT scanning

2 CASES: suddenly detected goiter

Regularly health check-up

+ Pediatric thyroid cancer is a rare and treatable disease with an excellent prognosis

+ Total thyroidectomy and central compartment lymph node dissection

+ RAI

+ Levothyroxine Therapy

It is important that pediatric DTC be managed by physicians with expertise in this area

Management of Thyroid Nodules and Differentiated Thyroid Cancer, Sanziana A Roman Julie Ann Sosa, Carmen C Solórzano

The Thyroid and Its Diseases_A Comprehensive Guide for the Clinician, Markus Luster

Leonidas H Duntas, Leonard Wartofsky

Thyroid Cancer_Advances in Diagnosis and Therapy, Hojjat Ahmadzadehfar

Thyroid Disorders_Basic Science and Clinical Practice, Syed Khalid Imam, Shamim I Ahmad