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Abstract
Purpose:
Thyroid cancer is rare in childhood. Although thyroid cancer is biologically more aggressive in children because of the high incidence of lymph node metastasis and distant metastasis when compared with that of adults, the prognosis is better. This study investigated the prognosis of pediatric differentiated thyroid cancer with 15 years or greater follow-up and we consider the proper treatment of pediatric differentiated thyroid cancer.
Methods:
From January, 1979 to December, 1994 during 16 years, 17 patients younger than 17 years old and who underwent thyroid surgery for well differentiated thyroid cancer at the Department of Surgery at Presbyterian Medical Center were retrospectively reviewed by the medical records and they were interviewed by telephone.
Results:
Total thyroidectomy was performed in 4 patients (23.5%), subtotal thyroidectomy was performed in 10 patients (58.8%) and lobectomy was performed in 3 patients (17.7%). The mean follow-up period was 23.5 years (range: 15∼28.2 years) and recurrence was found in 7 cases (41.3%). Five cases (29.5%) showed locoregional recurrence and 2 cases (11.8%) showed distant metastasis. Postoperative radioiodine (131I) therapy was done in 6 cases (35%) and 6 cases (35%) underwent radioiodine therapy as a therapeutic modality for metastasis.
Conclusion:
The pediatric well differentiated thyroid cancer in this study showed high rates of lymph node metastasis at the time of diagnosis and a high recurrence rate, but the prognosis was good (100% overall survival rate during the follow-up period). Therefore, total thyroidectomy, radical lymph node dissection and postoperative radioiodine therapy are considered the initial patient management. This aggressive therapeutic management can decrease of the recurrence rate and increase the therapeutic effect. A radioiodine scan and thyroglobulin can used for follow-up. (Korean J Endocrine Surg 2010;10:34-38)
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Table 1.
Characteristics of the patients
| Characteristics | |
|---|---|
| Total number | 17 |
| M：F | 4：13 (1：3.25) |
| Mean age (year) | 13.3 (6.5∼17) |
Table 2.
Chief complaint of the patients
| Symptoms | |
|---|---|
| Anterior neck mass | 15 (88.2%) |
| Cervical lymphadenopathy | 1 (5.9%) |
| Dyspnea due to thyroid mass | 1 (5.9%) |
Table 3.
Surgical procedures
Table 4.
Histopathology
| Type | Number |
|---|---|
| Papillary adenocarcinoma | 11 (64.7%) |
| Follicular adenocarcinoma | 4 (23.5%) |
| Papillary & follicular adenocarcinoma | 2 (11.8%) |
Table 5.
Recurrence
| Site | Number |
|---|---|
| Cervical lymph node | 3 (17.7%) |
| Local (Thyroid bed) Distant metastasis (Lung) | 2 (11.8%) 2 (11.8%) |
| Total | 7 (41.3%) |
Table 6.
Interval of recurrence and metastasis
| Type | Interval |
|---|---|
| Locoregional recurrence (5 case | s) 9.6 years (1∼16.5 years) |
| Distant metastasis (2 cases) | 7.4 years (1.3∼13.4 years) |
| Tortal (7 cases) | 9.0 years (1∼16.5 years) |
Table 7.
Postoperative RI (I-131) therapy
| Indication | Number | Dosage |
|---|---|---|
| Postoperative | 6 | 61.7 mci (30∼100 mci) |
| adjuvant treatment | ||
| Locoregional recurrence | 4 | 73.3 mci (70∼80 mci) |
| Lung metastasis | 2 | 150 mci (100∼200 mci) |
Table 8.
Comparison of the 1st operation and recurrence
| 1st operation | Interval of recurren | ce Recurrence | Treatment |
|---|---|---|---|
| Total thyroidectomy with Rt. MRND∗ and | 13.7 yrs | Thyroid bed | Follow up loss |
| Lt. jugular LND | |||
| Total thyroidectomy with Rt. RND† and Lt. | 8.8 yrs | Lt. upper jugular LN | Upper neck node excision＋RI |
| jugular LND | therapy (80 mci) | ||
| Total thyroidectomy with Rt. RND | 8.2 yrs | Lt. anterior jugular LN | Lt. Jugular LND＋RI therapy |
| (70 mci) | |||
| Subtotal thyroidectomy with Lt. RND | 1.3 yrs | Lung metastasis | RI therapy (100 mci) |
| Subtotal thyroidectomy | 1 yrs | Lt. jugular LN | MRND＋RI therapy (70 mci) |
| Subtotal thyroidectomy with Rt. RND and | 16.5 yrs | Thyroid bed | RI therapy (100 mci) |
| Lt. jugular LND | |||
| Subtotal thyroidectomy and Rt. RND | 13.4 yrs | Lung metastasis | RI therapy (200 mci) |
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