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Risk of structural persistent disease in pediatric patients with low or intermediate risk differentiated thyroid
Michele Klain1, Emilia Zampella1, Mariarosaria Manganelli1
1Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
Insights
Pediatric differentiated thyroid cancer (DTC) patients with high stimulated thyroglobulin (Tg) levels post-treatment face a higher risk of persistent disease. These Tg levels are key indicators for guiding treatment and follow-up strategies in young DTC patients.
Area of Science:
- Pediatric Endocrinology
- Oncology
- Nuclear Medicine
Background:
- Differentiated thyroid cancer (DTC) in children carries a significant risk of recurrence.
- The optimal use of postoperative radioactive iodine (RAI) therapy in pediatric DTC remains a subject of debate.
- Assessing outcomes in low and intermediate-risk pediatric DTC is crucial for refining treatment protocols.
Purpose of the Study:
- To evaluate the clinical outcomes of pediatric patients with low and intermediate-risk differentiated thyroid cancer.
- To identify predictors of disease recurrence or persistence in this patient cohort.
- To inform decisions regarding postoperative radioactive iodine (131I) administration and follow-up intensity.
Main Methods:
- Retrospective analysis of 45 pediatric DTC patients treated with surgery and 131I between 1992 and 2002.
- Exclusion of patients with detectable antithyroglobulin antibodies.
- Follow-up included biannual assessments of thyroglobulin (Tg) levels and imaging.
Main Results:
- A cumulative event rate of 33% (5% per person-year) was observed over a mean follow-up of 64 months.
- Persistent disease was more common in intermediate-risk patients and those with pre-131I Tg levels >10 ng/ml.
- Postoperative thyroid stimulating hormone-stimulated Tg levels >10 ng/ml independently predicted persistent disease.
Conclusions:
- Elevated postoperative stimulated Tg levels (>10 ng/ml) are significant predictors of persistent disease in pediatric DTC.
- These findings underscore the importance of stimulated Tg levels in tailoring initial treatment and long-term surveillance strategies.
- Optimizing RAI therapy and follow-up based on stimulated Tg levels can improve outcomes for pediatric DTC patients.
Purpose:
In pediatric patients with differentiated thyroid cancer (DTC), the risk of recurrence is high and the indication for postoperative 131I administration is still debated. The aim of this study was to assess the outcome in low and intermediate risk pediatric DTC patients.
Methods:
We retrospectively evaluated 45 pediatric patients with low or intermediate risk DTC, treated with surgery and 131I between 1992 and 2002 and with no detectable antithyroglobulin (Tg) antibodies. Follow-up was performed every 6-12 months with Tg blood level determination and imaging procedures.
Results:
During follow-up (64 ± 53 months), 15 events occurred (33% cumulative event rate, with an annual event rate of 5% person years). Five of these patients were submitted to additional surgery and all these 15 patients underwent a second 131I treatment course. All patients were alive at the end of the follow-up. Structural persistent disease occurred more frequently in patients at intermediate risk (p < 0.01) and in those with Tg values after thyroid hormone withdrawal >10 ng/ml before 131I therapy (p < 0.01). At multivariate analysis, only a postoperative thyroid stimulating hormone-stimulated Tg level >10 ng/ml was an independent predictor of persistent disease.
Conclusions:
In pediatric patients with DTC, postoperative high stimulated Tg values (>10 ng/ml) should be taken into account for deciding the extent of both initial treatment and follow-up.
