Best practice for the management of pediatric thyroid cancer

Abstract

The presentation of differentiated thyroid cancer in children often includes dissemination to lymph nodes. Despite this, the long-term prognosis is excellent with appropriate treatment. A few known hereditary syndromes are associated with paediatric thyroid cancer, although most tumours are sporadic. Ultrasound and cytology is used to evaluate suspect thyroid nodules, and treatment consists of surgery, radioactive iodine and thyroxine suppression therapy. Follow-up includes serum thyroglobulin measurements, serial ultrasounds of the neck, radioiodine whole body scans and occasionally other cross-sectional imaging or positron emission tomography. This review focuses on paediatric well differentiated follicular and papillary thyroid cancer, diagnosis and preoperative evaluation, underlying genetic mechanisms, surgery, other treatment options and follow-up.

Keywords::

• cancer
• child
• follow-up
• genetics
• paediatric
• radioactive iodine
• surgery
• thyroid
• treatment

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Pediatric well-differentiated thyroid cancer (WDTC) is often more advanced than adult WDTC at presentation.

• Pediatric WDTC has a high long-term recurrence rate, but despite this, an excellent long-term survival.

• Genetics in pediatric WDTC, especially in those caused by excessive external irradiation, differ from the genetics in adult WDTC.

• Total thyroidectomy together with prophylactic central lymph node dissection is advocated in most patients.

• ¹³¹I ablation is indicated for children with residual disease, and remnant or adjuvant ablation is recommended for most children, possibly exempting those with very low-risk tumors.

• Thyrotropin-suppressive therapy is indicated in all children with residual disease.

• Mainstay of follow-up after remission includes thyroglobulin measurements, serial ultrasounds of the neck and ¹³¹I WBS.

• MRI/computed tomography/FDG-PET may also be used for follow-up in WDTC in special circumstances, such as in the setting of negative ¹³¹I WBS and elevated thyroglobulin values.