Differentiated thyroid carcinoma in children and adolescents: clinical course and therapeutic approach

Thyroid carcinoma is an uncommon malignancy in the first two decades of life. It presents as a solitary thyroid nodule, multinodular goiter or as a long standing painless neck mass or both. Pediatric patients with thyroid carcinoma tend to present with more advanced disease than adults and have higher recurrence rates. The majority of all thyroid carcinomas in children and adolescents are of the papillary type. Surgery is the initial treatment, but the optimal surgical management is controversial. Ablation therapy with radioactive iodine, in order to destroy any thyroid remnant, and thyroxin therapy follow surgery. The prognosis even in cases with distant metastases is relatively good. Follow up should be performed at regular intervals and includes clinical examination, measurement of serum thyroglobulin levels, whole body scintigraphy and neck ultrasonography. As follow up is life long the care of these patients should be passed on to an adult endocrinologist. The consequences in adult patients with a history of childhood thyroid carcinoma should be evaluated.