Dynamic Observation in Children and Adolescents Following Management of Differentiated Thyroid Cancer

Abstract

Differentiated thyroid cancer (DTC) is one of the most common malignancies within the endocrine system, with a progressively increasing incidence over recent decades. In the structure of DTC, occurrence in the pediatric age group is relatively rare and is associated with excellent prognoses in terms of disease-specific survival. However, the prevalence of advanced disease in children and the frequency of recurrences present interdisciplinary teams with questions regarding the optimal management approach for such patients, focusing not on achieving disease eradication but preserving and maintaining quality of life. Notably, the presence of oncological pathology, coupled with fluctuations in thyroid hormone levels due to therapeutic interventions, underscores the importance of maintaining psychological and physiological well-being that are affected by the increased frequency of anxiety and depressive symptoms in children and their parents, as well as cognitive and physical functioning. These symptoms may exacerbate against the backdrop of hypothyroidism and directly correlate with TSH levels. To maintain quality of life during the period of dynamic observation and risk group re-stratification, we proposed a method of reduced thyroid hormone doses as an alternative to discontinuing thyroid hormones to assess stimulated thyroglobulin when reaching a threshold TSH level >30 mIU/L. The method was implemented in 2 pediatric patients, showing positive outcomes in terms of absence of hypothyroidism-related complaints, preservation of free thyroid hormone fractions, achievement of adequate target TSH levels, and informative tumor marker indicators. The results of our study underscore the importance of an individualized approach to the management of children with DTC and demonstrate the potential effectiveness of the reduced dose method in maintaining the quality of life of these patients. Further research and clinical observations are necessary for a deeper understanding of the applicability of this method and its impact on longterm outcomes.