title: The treatment of differentiated thyroid cancer in children: emphasis on surgical approach and radioactive iodine therapy.
abstract: Pediatric thyroid cancer is a rare disease with an excellent prognosis. Compared with adults, epithelial-derived differentiated thyroid cancer (DTC), which includes papillary and follicular thyroid cancer, presents at more advanced stages in children and is associated with higher rates of recurrence. Because of its uncommon occurrence, randomized trials have not been applied to test best-care options in children. Even in adults that have a 10-fold or higher incidence of thyroid cancer than children, few prospective trials have been executed to compare treatment approaches. We recognize that treatment recommendations have changed over the past few decades and will continue to do so. Respecting the aggressiveness of pediatric thyroid cancer, high recurrence rates, and the problems associated with decades of long-term follow-up, a premium should be placed on treatments that minimize risk of recurrence and the adverse effects of treatments and facilitate follow-up. We recommend that total thyroidectomy and central compartment lymph node dissection is the surgical procedure of choice for children with DTC if it can be performed by a high-volume thyroid surgeon. We recommend radioactive iodine therapy for remnant ablation or residual disease for most children with DTC. We recommend long-term follow-up because disease can recur decades after initial diagnosis and therapy. Considering the complexity of DTC management and the potential complications associated with therapy, it is essential that pediatric DTC be managed by physicians with expertise in this area.
authors: Department of Pediatrics, Yale Child Health Research Center, Yale University School of Medicine, 464 Congress Avenue, Room 237, New Haven, Connecticut 06520, USA. scott.rivkees@yale.edu
authors: Scott A
authors: SA
authors: Rivkees
authors: Ernest L
authors: EL
authors: Mazzaferri
authors: Frederik A
authors: FA
authors: Verburg
authors: Christoph
authors: C
authors: Reiners
authors: Markus
authors: M
authors: Luster
authors: Christopher K
authors: CK
authors: Breuer
authors: Catherine A
authors: CA
authors: Dinauer
authors: Robert
authors: R
authors: Udelsman
mesh_terms: D000293:Adolescent; D002648:Child; D003131:Combined Modality Therapy; D020249:Hormone Replacement Therapy; D006801:Humans; D007037:Hypothyroidism / Q000188:drug therapy / Q000209:etiology; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008197:Lymph Node Excision; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D012008:Recurrence; D013964:Thyroid Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D013965:Thyroidectomy / Q000009:adverse effects; D013974:Thyroxine / Q000627:therapeutic use
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; D013974:Thyroxine