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[Thyroid tumors in childhood]
J Cerdá1, A Rodríguez, E Molina
1Servicio de Cirugía Pediátrica, Hospital General Universitario Gregorio Marañón, Madrid.
Insights
Pediatric thyroid nodules are rare, with most being benign. However, careful evaluation is crucial to rule out rare cancers like papillary and medullary thyroid carcinoma, especially with a family history of endocrine neoplasia.
Area of Science:
- Pediatric Endocrinology
- Surgical Oncology
- Thyroid Pathology
Background:
- Thyroid pathology accounts for 5% of pediatric conditions, with infantile solitary thyroid nodules representing 1.2% of these cases.
- Thyroid tumors constitute 0.5% of all childhood tumors, with 10% occurring in individuals under 21 years old.
- Most infantile thyroid nodules are asymptomatic, presenting only as neck swelling, but family history is vital for investigating potential medullary carcinoma linked to multiple endocrine neoplasias.
Purpose of the Study:
- To present a series of pediatric patients with thyroid pathology requiring surgical intervention.
- To analyze the types of thyroid pathologies encountered, treatment strategies, and outcomes in children.
- To highlight the importance of a thorough diagnostic workup for pediatric thyroid nodules.
Main Methods:
- Retrospective review of 13 pediatric patients who underwent surgical treatment for thyroid pathology between 1983 and 1997.
- Diagnostic workup included thyroid gammagraphy, cervical ultrasound, and fine-needle aspiration (FNA) cytology.
- Surgical strategies were tailored based on diagnostic findings, ranging from total thyroidectomy to nodule excision.
Main Results:
- Five cases of papillary thyroid carcinoma (ages 7-14) and one case of medullary thyroid carcinoma associated with multiple endocrine neoplasia (MEN II 2A) were diagnosed.
- Papillary thyroid carcinoma cases were treated with total thyroidectomy followed by radioactive iodine (131I) ablation.
- Seven patients had benign thyroid nodules, including six adenomas and one colloid cyst (ages 8-15), treated with surgical excision.
Conclusions:
- While rare, thyroid cancer in children necessitates prompt diagnosis and appropriate surgical management.
- A comprehensive diagnostic protocol involving imaging and cytology is essential for guiding surgical strategy in pediatric thyroid nodules.
- Early detection and treatment are crucial for favorable outcomes in pediatric thyroid malignancies and benign conditions.
Abstract:
The thyroid pathology in the paediatric population represents 5% of the total and 1.2% only thyroid pathology correspond to the infantile solitary thyroid nodules. Most of them are asymptomatic and as only sign an increase of volume is observed in the neck. Always we have to ask about the family history because the possibility of medullary carcinoma related with multiple endocrine neoplasias should be investigated (a patient of our series). The thyroid tumor represents 0.5% of all the tumors and of these 10% is in younger than 21 years old. We present 13 patients with thyroid pathology that have required surgical treatment, since 1983 to 1997. Five papillary carcinomas (ages: 7 to 14 years old) that started with a cervical nodule, normal thyroid function and a case of medullary carcinoma, in a multiple endocrine neoplasia (MEN II 2A). In the 5 cases of carcinoma papillary we were carried out total thyroidectomy and later on, postoperative ablative dose of 131I was administered. In the case of the girl with medullary carcinoma was carried out a total tumorectomy and lymph node excision. Finally, seven patients with nodule thyroid were thyroid benign tumors (benign 6 adenomas and 1 cyst colloid, ages: 8 to 15 years old). In all of them we were carried out total surgical excision of the thyroid nodules. Our protocol of study of nodule thyroid includes: 1) thyroid gammagraphy to know the intensity of reception of the isotope; 2) cervical ultrasound; and 3) biopsy or cytopathology of fine needle aspiration of the thyroid gland in children that it dissuades to base the surgical strategy on this test.