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Burgwardt N, Healy JM, Menendez A, Regan M, Moote D, Bilbao N, Riba-Wolman R, Brimacombe M, Finck C. Validating the Modified McGill Thyroid Nodule Score for Assessment of Preoperative Risk of Pediatric Thyroid Malignancy. J Pediatr Surg 2024; 59:1394-1398. [PMID: 38614945 DOI: 10.1016/j.jpedsurg.2024.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/05/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVE The McGill Thyroid Nodule Score (MTNS) is a preoperative tool used to predict the risk for well-differentiated thyroid cancer in adults. It was developed by a multidisciplinary team using established evidence-based risk factors for thyroid cancer. The modified McGill Thyroid Nodule Score (mMTNS) was developed to predict malignancy risk in children. A pilot study suggested the mMTNS was able to assess malignancy risk in children with indeterminate cytology on fine needle aspiration (FNA). This study seeks to validate these findings. METHODS Retrospective chart review identified subjects who underwent FNA biopsy and subsequent resection. Each patient was assigned a score to compare to final pathology. Statistical analysis was performed with SPSS. All tests were 2-tailed and statistical significance defined p < 0.05. Logistic regression used to determine predictive values of scores. RESULTS 46 patients ≤21 years of age underwent resection of a thyroid nodule. Female predominance of 85% (n = 39). 78% (n = 36) of patients had palpable nodule. 65% (n = 30) found to have benign pathology and 35% (n = 16) found to have malignancy. Malignant nodules associated with greater mean mMTNS compared to benign [13.63 vs 7.23]. An mMTNS greater >12 had sensitivity of 86.7%, specificity of 90.3%, positive predictive value of 81.3%, and negative predictive value of 93.3%. CONCLUSION Our data suggests the mMTNS continues to be a useful adjunct in predicting malignancy risk of pediatric thyroid nodules. An mMTNS >12 has a high risk for malignancy, which can aid in counseling and clinical decision making, particularly when there is indeterminate cytology on FNA. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Nicolle Burgwardt
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA.
| | - James M Healy
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA
| | - Ana Menendez
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA
| | - Maia Regan
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA
| | - Douglas Moote
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA
| | - Nordie Bilbao
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA
| | - Rebecca Riba-Wolman
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA
| | - Michael Brimacombe
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA
| | - Christine Finck
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA
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Prasad PK, Mahajan P, Hawkins DS, Mostoufi-Moab S, Venkatramani R. Management of pediatric differentiated thyroid cancer: An overview for the pediatric oncologist. Pediatr Blood Cancer 2020; 67:e28141. [PMID: 32275118 DOI: 10.1002/pbc.28141] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/11/2019] [Accepted: 12/09/2019] [Indexed: 02/03/2023]
Abstract
Differentiated thyroid cancer (DTC) is the most common childhood thyroid malignancy. The standard of care for pediatric DTC is total thyroidectomy followed by radioactive iodine (RAI) treatment when indicated. Molecular changes and potential therapeutic targets have been recently described in pediatric thyroid cancer. Pediatric oncologists are increasingly involved in the evaluation of thyroid nodules in childhood cancer survivors and in the management of advanced thyroid cancer. In 2015, the American Thyroid Association published management guidelines for children with DTC. We provide an overview of the current standard of care and highlight available targeted therapies for progressive or RAI refractory DTC.
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Affiliation(s)
- Pinki K Prasad
- Louisiana State University Health Sciences Center, Children's Hospital of New Orleans, New Orleans, Louisiana
| | - Priya Mahajan
- Division of Hematology/Oncology, Department of Pediatrics, Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Douglas S Hawkins
- Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Sogol Mostoufi-Moab
- Divisions of Endocrinology and Hematology/Oncology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Rajkumar Venkatramani
- Division of Hematology/Oncology, Department of Pediatrics, Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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Kalladi Puthanpurayil S, Francis GL, Kraft AO, Prasad U, Petersson RS. Papillary thyroid carcinoma presenting as acute suppurative thyroiditis: A case report and review of the literature. Int J Pediatr Otorhinolaryngol 2018; 105:12-15. [PMID: 29447798 DOI: 10.1016/j.ijporl.2017.11.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022]
Abstract
Acute suppurative thyroiditis is a rare, potentially life-threatening condition. We report the case of a 17-year-old male who initially presented with a thyroid abscess. Due to persistent symptoms and lack of evidence for underlying predisposing factors, he was followed closely and subsequently diagnosed with papillary thyroid cancer. He was successfully managed with surgery. His clinical course, radiological evaluation, and pathology reports are presented here along with a review of the literature. This case of papillary thyroid cancer highlights the need for close follow-up of patients presenting with a thyroid abscess, when other predisposing risk factors are not evident.
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Affiliation(s)
- Shabana Kalladi Puthanpurayil
- Division of Endocrinology, Department of Pediatrics, Children's Hospital of Richmond, Virginia Commonwealth University Health System, 1000 E Broad St, Richmond, VA 23219, United States.
| | - Gary L Francis
- Division of Endocrinology, Department of Pediatrics, Children's Hospital of Richmond, Virginia Commonwealth University Health System, 1000 E Broad St, Richmond, VA 23219, United States
| | - Adele O Kraft
- Department of Pathology, Virginia Commonwealth University Health System, 1200 E Marshall St, Richmond, VA 23298, United States.
| | - Uma Prasad
- Department of Radiology, Virginia Commonwealth University Health System, 1200 E Marshall St, Richmond, VA 23298, United States.
| | - Rajanya S Petersson
- Department of Otolaryngology - Head and Neck Surgery, Children's Hospital of Richmond, Virginia Commonwealth University Health System, 1200 E Broad St, West Hospital, 12th Floor, South Wing, Suite 313, PO Box 980146, Richmond, VA 23298, United States.
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Parisi MT, Eslamy H, Mankoff D. Management of Differentiated Thyroid Cancer in Children: Focus on the American Thyroid Association Pediatric Guidelines. Semin Nucl Med 2016; 46:147-64. [PMID: 26897719 DOI: 10.1053/j.semnuclmed.2015.10.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
First introduced in 1946, radioactive iodine (I-131) produces short-range beta radiation with a half-life of 8 days. The physical properties of I-131 combined with the high degree of uptake in the differentiated thyroid cancers (DTCs) led to the use of I-131 as a therapeutic agent for DTC in adults. There are two indications for the potential use of I-131 therapy in pediatric thyroid disorders: nonsurgical treatment of hyperthyroidism owing to Graves' disease and the treatment of children with intermediate- and high-risk DTC. However, children are not just miniature adults. Not only are children and the pediatric thyroid gland more sensitive to radiation than adults but also the biologic behavior of DTC differs between children and adults as well. As opposed to adults, children with DTC typically present with advanced disease at diagnosis; yet, they respond rapidly to therapy and have an excellent prognosis that is significantly better than that in adult counterparts with advanced disease. Unfortunately, there are also higher rates of local and distant disease recurrence in children with DTC compared with adults, mandating lifelong surveillance. Further, children have a longer life expectancy during which the adverse effects of I-131 therapy may become manifest. Recognizing the differences between adults and children with DTC, the American Thyroid Association commissioned a task force of experts who developed and recently published a guideline to address the unique issues related to the management of thyroid nodules and DTC in children. This article reviews the epidemiology, diagnosis, staging, treatment, therapy-related effects, and suggestions for surveillance in children with DTC, focusing not only on the differences between adults and children with this disease but also on the latest recommendations from the inaugural pediatric management guidelines of the American Thyroid Association.
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Affiliation(s)
- Marguerite T Parisi
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA; Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA.
| | - Hedieh Eslamy
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - David Mankoff
- Department of Nuclear Medicine, University of Pennsylvania, Philadelphia, PA
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Abstract
Thyroid nodules are commonly diagnosed in adults. Although rare in children, the risk for thyroid cancer is much higher in the pediatric population compared with adults. Presenting as either a solitary nodule or a multinodular goiter, thyroid nodular disease in children requires a thorough workup that includes a detailed clinical examination comprised of prior history of thyroid disease in the patient or in their family, history of radiation exposure, careful palpation of the thyroid and lymph nodes, blood tests, ultrasonography, and cytological assessment. Thyroid surgery is the gold-standard treatment for pediatric thyroid nodules; nonetheless, the extent of surgery remains controversial. Because surgery is not without risk, the decision matrix necessitates focus on the benefits of surgery for the child contingent upon all the preoperative exams. New diagnostic technology such as molecular testing with fine needle aspiration biopsy may help distinguish between benign and malignant lesions while potentially decreasing surgery for benign disease. The objective of this review is to summarize new concepts in clinical disease management of nodular thyroid disease in the pediatric population, including patient history, medical examination, and diagnosis workup.
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Affiliation(s)
- Jeremy T Guille
- Division of Otolaryngology-Head and Neck Surgery, Division of General Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Adwoa Opoku-Boateng
- Division of Otolaryngology-Head and Neck Surgery, Division of General Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Susan L Thibeault
- Division of Otolaryngology-Head and Neck Surgery, Division of General Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Herbert Chen
- Division of Otolaryngology-Head and Neck Surgery, Division of General Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
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Abstract
BACKGROUND AND AIMS Paediatric thyroid cancer is a rare disease, making diagnosis and treatment particularly challenging. Here we present the Scottish experience of thyroid cancer in the paediatric population and give an overview of how a child or adolescent that presents with a thyroid nodule should be investigated and managed. METHODS AND RESULTS Data has been obtained from ISD Scotland, giving population-based information on paediatric thyroid cancer. A literature review has been performed on the management and treatment of thyroid cancer in the younger population. Paediatric thyroid cancer in Scotland is a rare disease, although the incidence is increasing each year. In general, differentiated paediatric thyroid cancer carries a good prognosis, while the results are more mixed in the rarer pathologies such as medullary cancer. CONCLUSION Due to the small numbers of patients diagnosed each year in Scotland, it is imperative that these patients are discussed at a multidisciplinary thyroid MDT and managed in a tertiary referral centre by consultants and medical/nursing support staff who have experience in treating these patients.
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Affiliation(s)
- C M Douglas
- Department of Paediatric ENT, Royal Hospital for Sick Children, UK
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Redlich A, Boxberger N, Schmid KW, Frühwald M, Rohrer T, Vorwerk P. Sensitivity of fine-needle biopsy in detecting pediatric differentiated thyroid carcinoma. Pediatr Blood Cancer 2012; 59:233-7. [PMID: 22184105 DOI: 10.1002/pbc.24051] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 11/21/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND Differentiated thyroid carcinomas (DTC) are uncommon in children. Since the frequency of malignancy is assumed to be high in pediatric symptomatic thyroid nodules, carcinomas should be ruled out reliably. The objective of this study was to assess the sensitivity of fine-needle biopsy (FNB) in diagnosing children with DTC. PROCEDURE We retrospectively analyzed 15 years of data from the GPOH-MET registry, a database by the German Society for Pediatric Oncology and Hematology (GPOH) with a focus on malignant endocrine tumors (MET). We reviewed data on pediatric patients with DTC who had undergone FNB. FNB results were classified according to well-established guidelines. RESULTS During the study period, 206 children with a histological diagnosis of DTC were entered into the GPOH-MET database. Fifty of those patients aged 3.6-17.3 years (mean, 12.3 years) had undergone FNB preoperatively. Forty-one were diagnosed with papillary thyroid carcinoma (PTC), seven with follicular thyroid carcinoma (FTC), and two had DTC not otherwise specified. Of the first FNB performed on each patient, the cytological specimens were diagnosed as benign in 13 cases, malignant in 14, suspicious in 9, follicular neoplasms in 6, and unsatisfactory in 8. The sensitivity of FNB in detecting DTC was 69.0%. CONCLUSIONS Our results reflect the current practice of pediatric thyroid FNB in Germany. In order to improve its usefulness, FNB should always be performed by experienced physicians. Furthermore, a central review of all specimens is necessary to ascertain the validity of the cytological diagnosis and to introduce immunocytological and molecular methods.
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Affiliation(s)
- Antje Redlich
- Department of Pediatric Hematology and Oncology, Otto-von-Guericke-University Magdeburg, GPOH-MET Study Center, Magdeburg, Germany
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O'Gorman CS, Hamilton J, Rachmiel M, Gupta A, Ngan BY, Daneman D. Thyroid cancer in childhood: a retrospective review of childhood course. Thyroid 2010; 20:375-80. [PMID: 20373982 DOI: 10.1089/thy.2009.0386] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Thyroid cancer (TC) is an uncommon childhood malignancy, but the incidence may be increasing. Recent American Thyroid Association guidelines focus primarily on adult data. Natural history studies of TC in childhood are important to determine outcomes. The objectives of this study were to describe the demographics and outcomes in children with TC treated at The Hospital for Sick Children, Toronto, from 1983 to 2006. We hypothesized that childhood TC was increasing at our institution. METHODS Cases of papillary TC (PTC) (including follicular variant PTC) and follicular TC (FTC) were identified from pathology databases. Chart review was performed, and data were extracted on clinical, treatment, and outcome variables. RESULTS Sixty-one cases were identified, and complete data were available in 54, including 36 girls and 18 boys. There was no statistical change in numbers of cases diagnosed yearly during the study period. Younger children were more likely to have metastases at presentation or during follow-up. Pathological TC diagnosis included 40 PTC, 1 diffuse-sclerosing papillary, 7 follicular variant PTC, and 6 FTC. There was no difference in pathology findings between children less than or greater than 10 years old. Five patients had a history of previous malignancy, and five had a history of previous thyroid conditions. Three patients were born in areas of high TC endemnicity. Twenty-three patients had thyroiditis on pathology examination. All patients underwent total thyroidectomy, and 53/54 patients received therapeutic radioactive iodine ablation. Twenty-seven patients had metastases at presentation (19 lymph nodes only, 2 lung only, and 6 lymph node and distant) and 6 developed distant metastases during follow-up (3 lung, 2 thymus, and 1 paraspinal). Male sex was associated with development of metastases during follow-up. On multiple regression, tumor size was predicted positively by PTC but not by age, sex, or metastases at presentation or during follow-up. CONCLUSION We did not find evidence of increasing numbers of cases of TC diagnosed yearly during the study period, or difference in tumor aggressiveness, or between outcomes in children aged less than or greater than 10 years. Children with metastases at presentation or during follow-up were likely to be younger than children without metastases. There is a need for prospective, collaborative multicenter studies of TC.
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Lin JD. Thyroid Cancer in Thyroid Nodules Diagnosed Using Ultrasonography and Fine Needle Aspiration Cytology. J Med Ultrasound 2010. [DOI: 10.1016/s0929-6441(10)60014-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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The Canadian Pediatric Thyroid Nodule Study: an evaluation of current management practices. J Pediatr Surg 2008; 43:826-30. [PMID: 18485947 DOI: 10.1016/j.jpedsurg.2007.12.019] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Accepted: 12/03/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND/PURPOSE Thyroid nodules in children often require surgical treatment. We evaluated management practices for these across Canada. METHODS Patient records from 9 Canadian pediatric centers of children undergoing surgery for thyroid nodules over a 6-year period were reviewed. Demographics, presenting features, investigations, surgical treatment, pathology, and complications were assessed. RESULTS One hundred and forty-one patients were reviewed (75% female), of whom 117 presented with a palpable mass. Ultrasound and/or thyroid scintigraphy was the most commonly used preoperative imaging studies. Fine-needle aspiration cytology correlated with final pathology in 49% of cases. Overall, the rate of malignancy in this series was 43%, with half being papillary carcinoma. Thirty-two of 57 patients undergoing primary total thyroidectomy had a malignancy; 14 of these had positive preoperative fine-needle aspiration cytologies. Twenty of 71 patients undergoing initial hemithyroidectomy +/- isthmusectomy had a malignancy. Seventeen of these went on to completion thyroidectomy and 3 had malignancy in the second specimen. Hypocalcemia and hoarseness occurred in 14 and 4 patients, respectively. Complications were more common after primary total thyroidectomy; none occurred in patients undergoing completion thyroidectomy. CONCLUSIONS The incidence of malignancy in pediatric thyroid nodules is high, and the risk of surgical complications significant. With variable management practices across Canada, evidence-based guidelines for diagnosis and surgical treatment may be valuable.
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Parisi MT, Mankoff D. Differentiated Pediatric Thyroid Cancer: Correlates With Adult Disease, Controversies in Treatment. Semin Nucl Med 2007; 37:340-56. [PMID: 17707241 DOI: 10.1053/j.semnuclmed.2007.05.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The biologic behavior of differentiated thyroid cancer can differ between adults and children, especially in those children younger than 10 years of age. Unlike adults, young children typically present with advanced disease at diagnosis. Despite this, children respond rapidly to therapy and have an excellent prognosis that is significantly better than that of their adult counterparts with advanced disease. In contradistinction to adults, children with thyroid cancer also have higher local and distant disease recurrences with progression-free survival of only 70% at 5 years, mandating life-long surveillance. Although thyroid cancer is the most common carcinoma in children, overall incidence is low, a factor that has prevented performance of a controlled, randomized, prospective study to determine the most efficacious treatment regimen in this age group. So, although extensively investigated, treatment of pediatric patients with differentiated thyroid cancer remains controversial. This article reviews the current controversies in the treatment of pediatric differentiated thyroid cancer, focusing on issues of optimal initial and subsequent therapy as well as that of long-term follow-up. Our approach to treatment is presented. In so doing, similarities and differences between adults and children with differentiated thyroid cancer as regards unique considerations in epidemiology, diagnosis, staging, treatment, therapy-related late effects, and disease surveillance are presented. The expanding use of and appropriate roles for thyrogen and fluorine-18-fluorodeoxyglucose positron emission tomography in disease evaluation and surveillance will be addressed.
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Affiliation(s)
- Marguerite T Parisi
- Department of Radiology, Children's Hospital and Regional Medical Center, and Department of Radiology, University of Washington, Seattle, WA 98105, USA.
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Abstract
OBJECTIVES The aims of our study were to review the Royal Children's Hospital cohort of children having thyroidectomy for thyroid nodules over the last 8 years and to report the changing pattern of thyroid cancer seen in our institution over that time. METHODS We undertook a retrospective case-note review of all patients who underwent thyroid surgery between 1997 and 2004. RESULTS Of 69 patients identified, the pathological diagnoses were 51 benign tumours, 14 thyroid cancers and four cases of multiple endocrine neoplasia type 2, who were treated with prophylactic thyroidectomy. Sixteen of the 69 patients had a history of childhood cancer and 10/16 had cancer treatment which included direct or scatter radiation. Of the 10 patients who received irradiation, four had follicular adenomas and six developed thyroid cancer. All six patients were euthyroid: one patient was presented with a palpable nodule and the other five were detected on surveillance ultrasound. CONCLUSIONS Our results confirm a high detection of malignancy in thyroid nodules in childhood. Compared to an earlier study at this institution, the number of thyroid malignancies appears to be increasing. Surveillance at the Royal Children's Hospital has changed, with increased long-term cancer survival. Prospective 2-yearly evaluation of those with a past history of radiation exposure has resulted in earlier detection of benign and malignant thyroid lesions. Nodular changes are usually not clinically apparent for many years and lifelong surveillance is necessary for cancer detection in this group.
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Affiliation(s)
- R Hameed
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia
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Koch CA, Sarlis NJ. The spectrum of thyroid diseases in childhood and its evolution during transition to adulthood: natural history, diagnosis, differential diagnosis and management. J Endocrinol Invest 2001; 24:659-75. [PMID: 11716153 DOI: 10.1007/bf03343911] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In this contribution, we review current knowledge on the pathogenesis, diagnosis and differential diagnosis of thyroid disorders in childhood and adolescence, as well as present an update on therapy methods and management guidelines for these disorders. This overview is conceptually divided into two parts, one focusing on thyroid functional disorders, i.e. conditions leading to hyper- and hypothyroidism, and another one pertinent to structural abnormalities of the thyroid gland, i.e. nodular disorders and thyroid cancer. Currently, congenital hypothyroidism is diagnosed in a much more timely fashion rather than in the past, rendering hypothyroidism-related mental retardation and developmental deficits very rare in newborns and children and, hence, diminishing significantly its public health impact. At the same time, considerable advances have occurred in our understanding of the molecular basis of several genetic conditions affecting the thyroid gland in childhood, such as familial non-autoimmune hyperthyroidism, as well as of the pathways leading to thyroid neoplasia.
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Affiliation(s)
- C A Koch
- Pediatric and Reproductive Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
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Abstract
Carcinoma of the thyroid gland is unusual in children and represents only about 3% of pediatric malignancies. Surgical management is the principal method of treatment, but there is considerable controversy regarding exactly how much of the thyroid gland should be removed for adequate treatment. There also is controversy regarding the use of fine-needle aspiration (FNA) in the evaluation of potentially neoplastic thyroid lesions. In this report, the pertinent literature is reviewed regarding these issues. Moreover, this report will discuss recent discoveries that have elucidated some of the molecular biological events responsible for the development of thyroid cancer.
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Affiliation(s)
- M A Skinner
- Duke University Medical Center, Durham, NC 27710, USA
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Bergman P, Auldist AW, Cameron F. Review of the outcome of management of Graves' disease in children and adolescents. J Paediatr Child Health 2001; 37:176-82. [PMID: 11328475 DOI: 10.1046/j.1440-1754.2001.00641.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To review our recent experience in the management of paediatric Graves' disease, the leading cause of hyperthyroidism in childhood, in view of ongoing international debate regarding therapy. METHODOLOGY Retrospective medical record review of patients with Graves' disease, treated between 1985 and 1999, at the Royal Children's Hospital, Melbourne. RESULTS Forty patients, aged at diagnosis between 2.9 and 17.6 years (median age 11 years; 31 females), were treated. Thirty-three patients received either definitive therapy or at least 24 months medical therapy and follow up at the time of the study. Six patients experienced successful remission upon withdrawal of medication (median medication duration 3.2 years; four females; median follow up 4.1 years). Children successfully achieving remission were younger at presentation than those requiring surgery (9.5 vs 12.9 years, respectively; P = 0.01). Ten patients were treated surgically, leaving 4-6 g residual thyroid tissue. Surgical indications included failed initial medical therapy, relapse after medication cessation, non-compliance and significant medication side effects. During a median follow up of 1.7 years (range 0.2-5 years), three of 10 patients have subsequently relapsed and four of 10 patients are receiving postoperative thyroxine replacement. Transient hypocalcaemia occurred in five patients and temporary recurrent laryngeal nerve palsy occurred in two patients. CONCLUSIONS Fewer than 20% of children experienced successful sustained remission at median follow up of 3.2 years. Medication remains a well-tolerated therapeutic option. Surgery is a reasonable alternative when there are specific indications. In order to decrease the likelihood of surgical relapse, less than 4 g thyroid tissue should be left postoperatively.
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Affiliation(s)
- P Bergman
- Centre for Hormone Research, Department of Endocrinology and Diabetes, Royal Children's Hospital, Parkville, Victoria, Australia
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Al-Shaikh A, Ngan B, Daneman A, Daneman D. Fine-needle aspiration biopsy in the management of thyroid nodules in children and adolescents. J Pediatr 2001; 138:140-2. [PMID: 11148531 DOI: 10.1067/mpd.2001.109609] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We reviewed the utility of fine-needle aspiration biopsy (FNAB) in the management of thyroid nodules in 41 children and adolescents (35 girls; mean age, 13.3 years). Cytologic findings were benign in 30, malignant in 2, suspicious in 6, and insufficient in 3. The malignancy rate was 5%, with no false-negative results. Diagnostic accuracy for FNAB was 87% and inter-observer reliability was 88%. FNAB is safe and highly accurate in the evaluation of thyroid nodules in childhood.
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Affiliation(s)
- A Al-Shaikh
- Department of Endocrinology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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