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Papillary Thyroid Carcinoma in Children: Clinicopathological Profile and Outcomes of Management
John K Thomas1, Jujju Jacob Kurian1, Anish Jacob Cherian2
1Dept of Pediatric Surgery, Christian Medical College, Vellore, India.
Insights
Pediatric papillary thyroid carcinoma (PTC) often presents aggressively with high rates of metastasis. Management involves surgery and radioactive iodine therapy, with significant risks of hypocalcemia and persistent disease. Metastatic lymph nodes and tumor size are key predictors of outcomes.
Area of Science:
- Pediatric Oncology
- Endocrinology
- Surgical Oncology
Background:
- Papillary thyroid carcinoma (PTC) in children presents unique challenges compared to adults.
- Understanding the clinicopathological profile and management outcomes is crucial for optimizing pediatric PTC care.
Purpose of the Study:
- To analyze the clinicopathological characteristics of pediatric papillary thyroid carcinoma.
- To evaluate the outcomes of various management strategies for children with PTC.
- To identify risk factors associated with persistent and metastatic disease in pediatric PTC.
Main Methods:
- Retrospective analysis of clinical data for 82 children (≤18 years) diagnosed with PTC between January 2006 and July 2018.
- Data included presentation, surgical procedures, post-operative complications, and follow-up until December 2019.
- Statistical analysis to identify risk factors for disease persistence and metastasis.
Main Results:
- 47.6% of pediatric PTC patients presented with cervical lymphadenopathy and 11% with systemic metastasis.
- Total thyroidectomy with selective neck dissection was the most common surgical approach (47.6%).
- Post-operative hypocalcemia occurred in 47.6% (34.1% temporary, 13.4% permanent).
- 34% developed persistent disease after surgery and radioactive iodine therapy.
- Metastatic cervical lymph nodes at presentation and tumor size were significant risk factors for persistent and metastatic disease, respectively.
Conclusions:
- Pediatric papillary thyroid carcinoma frequently presents with aggressive features, including nodal and distant metastasis.
- Significant rates of post-thyroidectomy hypocalcemia necessitate ongoing efforts for reduction.
- Metastatic cervical lymph nodes and tumor size are critical indicators for predicting disease persistence and metastasis in pediatric PTC.
Background:
We aim to analyze the clinicopathological profile and outcomes of management for children with papillary thyroid carcinoma (PTC).
Methods:
Relevant clinical data of children ≤ 18 years of age managed for PTC between January 2006 and July 2018 as well as details of their follow-up till December 2019 were retrospectively collected and analyzed.
Results:
There were 82 children with PTC that were managed during the study period. At presentation, 39 (47.6%) had cervical lymphadenopathy, while 9 (11%) had systemic metastasis. Majority of patients 39 (47.6%) underwent total thyroidectomy with a selective neck dissection, while total thyroidectomy alone was performed in 26 (31.7%). Following surgery, hypocalcemia was seen in 39 (47.6%): 28 (34.1%) were temporary, while 11 (13.4%) were permanent. Twenty-eight (34%) developed persistent disease after surgery and 131I therapy. Significant risk factors for persistence and metastatic disease were metastatic cervical lymph node at presentation (p = 0.002) and tumor size (p = 0.014), respectively. The mean duration of follow-up was 60.3 (range 12-150) months with a mean overall disease-free survival of 60 months (95% CI 57.11, 77.95).
Conclusion:
Children with papillary thyroid cancers present with aggressive disease, 47.6% with cervical nodal metastasis and 11% with distant metastasis in this cohort. The rate of post-thyroidectomy hypocalcemia in this study is substantial, and efforts to reduce it are actively being pursued. The presence of metastatic cervical lymph node at presentation (p = 0.002) and tumor size (p = 0.014) were the only significant risk factors for persistent and metastatic disease, respectively, in this study.
