IS THE INCIDENCE OF CHILDHOOD THYROID CARCINOMA DECLINING?

Abstract

In the last 15 years 32 children aged 6 to 19 have been referred to Massachusetts Gen. Hosp. with solitary thyroid nodules. Excisional biopsy revealed carcinoma in 5 (15%), adenoma in 18 (56%), and miscellaneous diagnoses in 9 (28%). Patients with carcinoma, ages 7-15, gave no history of x-ray exposure in infancy, and all were euthyroid. Lymph node metastases were present in all at the time of diagnosis. Treatment included thyroidectomy, modified radical node dissection, and mediastinal explorations, and postoperative full replacement thyroid therapy. Two patients were treated with I131 additionally. One of these died of lung metastases; the other was lost to follow-up. The remainder, followed for 4-8 years, were disease free when last seen. Benign thyroid tumors were present in 4 boys and 14 girls, ages 6 to 19, with a mean age of 14. All were euthyroid; 8/18 had technetium scans showing 6 “warm” and 2 “cold” nodules. At surgery there were 15 follicular adenomas, 2 fetal adenomas, and a Hurthle cell adenoma. Miscellaneous conditions seen in the remaining patients included ectopic normal thyroid tissue and agenesis of the left thyroid lobe. In the past, 50% of nodules in childhood were malignant (1). Our series, born since knowledge of the danger of irradiation induced malignancies became widespread, suggests the incidence of childhood thyroid carcinoma may be declining. (1) Hayles, A. B., et al., Amer. J. Surg. 106: 735, 1963.