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268 Thyroid and Parathyroid Glands
Table 40.3: Evidence-based research.
Title Childhood and adolescent thyroid carcinoma
Authors Grigsby PW, Gal-or A, Michalski JM, Doherty GM
Institution Department of Radiation Oncology, Washington University
Medical Center, St. Louis, Missouri, USA; Department of
Surgery, Washington University Medical Center, St. Louis,
Missouri, USA
Reference Cancer 2002; 95:724–729
Problem Reports on the specific factors that predict the risk of
developing recurrent disease in children are scanty. This
study was performed to evaluate the influence of clinical
and treatment factors on local tumour control, control of
distant metastasis survival, and complications in children and
adolescents with thyroid carcinoma.
Outcome/ The study involved 56 children, ages 4–20 years; there were
effect 43 females and 13 males. The overall survival rate was 98%
with a follow-up of 0.6–30.7 years (median follow-up, 11.0
years). The 10-year progression-free survival rate was 61%.
Nineteen patients (34%) experienced a recurrence of their
thyroid carcinoma. The time to first recurrence of disease
ranged from 8 months to 14.8 years (mean, 5.3 years). None
of those with disease confined to the thyroid developed
recurrent disease. The recurrence rate was 50% (17 of 34)
in patients with lymph node metastasis and 29% (2 of 7)
in patients with lung metastasis (P = 0.02).Thyroid capsule
invasion (P = 0.02), soft tissue invasion (P = 0.03), positive
margins (P = 0.006), and tumour location at diagnosis (thyroid
only versus thyroid and lymph nodes versus thyroid, lymph
nodes, and lung metastasis, P = 0.02) were significant for
developing recurrent disease. Patients younger than 15 years
of age at diagnosis were more likely to have more extensive
tumours at diagnosis than patients who were 15 years of
age and older (thyroid only versus thyroid and lymph nodes
versus thyroid, lymph nodes, and lung metastasis, P = 0.02).
Historical Carcinoma of the thyroid in children and adolescents has little
significance/ risk of mortality but a high risk of recurrence. Younger patients
comments present with a more advanced stage of disease and are more
likely to have disease recurrence. Total thyroidectomy and
lymph node dissection, followed by postoperative I therapy,
131
thyroid hormone replacement (suppressive) administration,
and diligent surveillance are warranted

Key Summary Points

1. Simple goiter occurs with a wide range of prevalence (1–6%) 6. Juvenile autoimmune thyroiditis is one of the most frequent
in different populations of children and adolescents. thyroid diseases in childhood.
2. A diffuse thyroid enlargement is the most common form of 7. Thyroid hormone treatment is used in established cases of
goiter in small children. goiter before cystic degeneration sets in to decrease the size
of the goiter or arrest its further growth.
3. Graves’ disease is relatively uncommon in children.
8. Endemic goiter can be reversed with iodide and/or thyroxin in
4. Thorough examination of the thyroid, even in apparently
healthy children in regions of regular iodine intake, is the early stages. Response is generally poor or negligible after
the formation of nodules and onset of cystic degeneration.
necessary to detect thyroid disorder.
9. Carcinoma of the thyroid in children and adolescents has little
5. Although thyroid nodules are unusual in childhood and risk of mortality but a high risk of recurrence.
adolescence, they demand careful consideration because of
the likelihood that they may represent malignancy.

References

1. Rallison ML, Dobyns BM, Meikle AW, et al. Natural history of 3. Hogan A, Zhuge Y, Perez E, et al. Pediatric thyroid carcinoma:
thyroid abnormalities: prevalence, incidence, and regression of incidence and outcomes in 1753 patients. J Surg Res 2009;
thyroid disease in adolescents and young adults. Am J Med 1991; 156:167–172.
91:363–370.
4. Thompson NM, Geiger JM. Thyroid/parathyroid. In: O’Neil JA,
2. Nwako FA. Surgical lesions of the neck. In: Nwako FA (ed). A Rowe MI, Grofeld JI, Fonkalsrud ER, Coran AG, eds. Pediatric
Textbook of Pediatric Surgery in the Tropics. Macmillan, 1980, Pp Surgery. Mosby, 1998, Pp 743–755.
128–137.