Abstract
BackgroundThe available studies concerning the influence of age on the phenotypical expression of differentiated thyroid carcinoma (DTC) have hitherto compared DTC presentation either between pre-pubertal and pubertal children or between pediatric patients and aged adults; aim of this study was to ascertain for the first time whether presentation of DTC may significantly vary according to age, even within a peculiar study population covering only young patients aged less than 30 years.MethodsThe main clinical, biochemical and pathologic data at DTC diagnosis were retrospectively recorded in 2 selected cohorts including, respectively, 18 children and adolescents aged less than 18 years (Group A) or 45 young adults aged between 20 and 29.8 years (Group B).ResultsThe statistical distribution of DTC cases in the different age ranges was found to progressively increase with increasing age; furthermore, the patients of Group A exhibited at diagnosis a more severe clinical involvement and a higher rate of extra-regional metastases; finally, also the association with both autoimmune thyroid diseases (AITDs) and a biochemical hypothyroid pattern was more common in Group A patients.ConclusionsIn a study population younger than 30 years: a) the risk of developing DTC increases with age, achieving its zenith during the 3rd decade of life; b) clinical presentation is more severe in children and adolescents younger than 18 years than in the patients aged between 20 and 30; c) in the cohort of children and adolescents DTC is more often associated with AITDs, which might play some role in conditioning the more aggressive phenotypical presentation of DTC in this patient group.
Highlights
The available studies concerning the influence of age on the phenotypical expression of differentiated thyroid carcinoma (DTC) have hitherto compared DTC presentation either between pre-pubertal and pubertal children or between pediatric patients and aged adults; aim of this study was to ascertain for the first time whether presentation of DTC may significantly vary according to age, even within a peculiar study population covering only young patients aged less than 30 years
Study population It consisted of all the 63 patients < 30 years of age with primary thyroid cancer and well-documented histologic diagnosis of DTC, who were identified in our Departments during the period 1999–2016
The patients with a hypoechogenic gland pattern at US compatible with autoimmune thyroid diseases (AITDs) and positivity for serum thyroid peroxidase autoantibody (TPOAb) and/or thyroglobulin autoantibody (TGAb) were considered as having an association between DTC and Hashimoto’s thyroiditis (HT)
Summary
The available studies concerning the influence of age on the phenotypical expression of differentiated thyroid carcinoma (DTC) have hitherto compared DTC presentation either between pre-pubertal and pubertal children or between pediatric patients and aged adults; aim of this study was to ascertain for the first time whether presentation of DTC may significantly vary according to age, even within a peculiar study population covering only young patients aged less than 30 years. Other studies have demonstrated that primary thyroid cancer in pediatric patients differs from primary thyroid carcinoma in adults with respect to both presentation and clinical course [5,6,7]. In children, the Zirilli et al Italian Journal of Pediatrics (2018) 44:13 more aggressive clinical presentation is not generally associated with a more severe long-term prognosis [9]. Due to all these differences, which seem to characterize the phenotypical expression of DTC in children and adolescents, the American Thyroid Association has recently prepared specific recommendations for the management of thyroid nodules and DTC in young patients up to 18 years of age [10]
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