Pediatric thyroid cancer.
OBJECTIVE
The treatment of pediatric thyroid cancer evokes considerable controversy. The extent of surgery and role of postoperative radioactive iodine are not clearly defined. We analyzed the behavior of pediatric thyroid cancers and its management.


METHODS
Eighty-three patients, from 1964-2000, were identified by a search of our database. The clinical course of 26 patients was not evaluated because of inadequate follow-up and the remaining 57 patients were included in the final survival analysis. These 26 patients were included for analyses of epidemiological data.


RESULTS
There were 27 males and 56 females. Cervical lymphadenopathy was a common presentation (57.8%). The predominant histology was papillary carcinoma (57%). Sixteen patients (19.2%) had pulmonary metastases at presentation. Patients with cervical nodes had a significantly higher incidence of pulmonary metastasis compared to those who presented with thyroid nodule (P = 0.037). Five patients (31.2%) with pulmonary metastases had a negative chest X-ray and were detected only on the radioiodine scan. At median follow-up of 64 months, all 57 patients were alive, 10 with disease and 47 disease free.


CONCLUSIONS
Despite its advanced stage at presentation, pediatric thyroid cancer is associated with an excellent prognosis. We advocate total thyroidectomy and radioactive iodine as the best management option as the incidence of pulmonary metastases is high.
Chaukar
Devendra A
DA
Department of Head and Neck surgery, Tata Memorial Hospital, Ernest Borges Road, Parel, Mumbai, India. dchaukar@rediffmail.com
Rangarajan
Venkatesh
V
Nair
Narendra
N
Dcruz
Anil K
AK
Nadkarni
Mandar S
MS
Pai
Prathmesh S
PS
Mistry
Rajesh C
RC
D000293:Adolescent; D002291:Carcinoma, Papillary / Q000175:diagnosis / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary*; D008206:Lymphatic Diseases / Q000150:complications; D008297:Male; D011379:Prognosis; D013902:Radiography, Thoracic; D015996:Survival Rate; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016606:Thyroid Nodule / Q000175:diagnosis / Q000000981:diagnostic imaging; D013965:Thyroidectomy / Q000379:methods*
D007457:Iodine Radioisotopes