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Published on: June 9, 2023
Differentiated thyroid cancer in children: diagnosis and management
Catherine A Dinauer1, Christopher Breuer, Scott A Rivkees
1Yale Pediatric Thyroid Center, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06520-8081, USA. catherine.dinauer@yale.edu
Insights
Optimal treatment for pediatric differentiated thyroid cancer requires further study. Recent findings support total thyroidectomy and radioactive iodine, but more research is needed on lymph node dissection and genetic analysis.
Area of Science:
- Pediatric Endocrinology
- Oncology
- Surgical Oncology
Background:
- Differentiated thyroid cancer is the most common pediatric endocrine malignancy.
- Pediatric patients often present with advanced disease but have a better prognosis than adults.
- Existing guidelines primarily focus on adult treatment protocols.
Purpose of the Study:
- To review current management strategies for differentiated thyroid cancer in children.
- To highlight differences in presentation and outcomes between pediatric and adult patients.
- To identify areas requiring further research in pediatric thyroid cancer treatment.
Main Methods:
- Retrospective analysis of available data on pediatric differentiated thyroid cancer.
- Review of recent large case series on treatment approaches.
- Examination of advances in understanding genetic abnormalities.
Main Results:
- Recent case series support total thyroidectomy followed by radioactive iodine for remnant ablation.
- Genetic abnormalities associated with pediatric thyroid cancer are increasingly understood.
- Pediatric differentiated thyroid cancer shows a more favorable outcome despite advanced presentation.
Conclusions:
- Optimal treatment for pediatric differentiated thyroid cancer remains under debate.
- Further collaborative studies are essential to refine surgical techniques, radioactive iodine protocols, and the role of genetic analysis.
- Current data provide valuable insights into managing this rare pediatric disease.
Purpose Of Review:
Differentiated thyroid cancer is the most common endocrine malignancy in children. In 2006, the American Thyroid Association Guidelines Taskforce released detailed management recommendations for differentiated thyroid cancer, which primarily addressed the approach for treating adult patients. Children with differentiated thyroid cancer present with more advanced disease and yet have a more favorable outcome than adults. Thus optimal treatment for younger patients with differentiated thyroid cancer may differ from that for adults.
Recent Findings:
All available data regarding differentiated thyroid cancer treatment in children are retrospective. In the past year, several large case series have been published that strengthen the argument for total thyroidectomy at the time of diagnosis, followed by administration of radioactive iodine for remnant ablation. There have also been recent advances in understanding the genetic abnormalities associated with pediatric thyroid cancer.
Summary:
The optimal treatment of differentiated thyroid cancer in pediatric patients continues to be debated. Recent publications from institutions around the world provide useful data regarding current approaches to this unusual disease. Further collaborative studies are needed to further refine the surgical approach, particularly the extent of lymph-node dissection, radioactive iodine dosing, and the role of genetic analysis in diagnosis and clinical approach.
