Abstract
A 12-year-old girl presented with a 4 year history of an enlarged, firm thyroid gland. On exam, her thyroid was firm and fixed and an enlarged cervical lymph node was palpable as well. Though a thyroid ultrasound prior to referral was read as thyroiditis, clinical suspicion for thyroid carcinoma mandated continued investigation. The diagnosis of papillary thyroid cancer was established and her workup revealed lymph node metastases as well as a tremendous burden of pulmonary metastases. Pediatric thyroid cancer is extremely rare, but often presents with aggressive disease. Palpable thyroid abnormalities in an individual under 20-years-old should be viewed with suspicion and should be thoroughly investigated to rule out malignancy even in the face of negative diagnostic procedures. Though pediatric papillary thyroid cancer often presents with loco-regional and even distant metastatic disease, mortality rates in follow-up for as long as 20 years are very favorable.
Highlights
Thyroid cancer occurring under the age of 20 years is a very rare occurrence with an incidence from 1975–1995 of < 2/100,000 children and adolescents
In contrast to adult papillary thyroid carcinoma, pediatric papillary thyroid carcinoma tends to be more aggressive at presentation with a higher incidence of multifocality, neck lymph node disease and extracapsular extension [2,3]
The following case details an aggressive presentation of pediatric papillary thyroid cancer and illustrates the importance of vigilance in the context of an abnormal thyroid physical exam in a child
Summary
Thyroid cancer occurring under the age of 20 years is a very rare occurrence with an incidence from 1975–1995 of < 2/100,000 children and adolescents. Journal of Medical Case Reports 2007, 1:29 http://www.jmedicalcasereports.com/content/1/1/29 weight of 92 pounds Her exam was significant for a diffusely enlarged thyroid gland of approximately 45 grams with an irregular contour and a nodular thickening near the isthmus on the left lobe. The lung uptake was estimated to be 45% and based on geometric mean calculation determined by proprietary software, 150 mCi was considered to be the maximum tolerated dose that would most likely avoid radiation induced pulmonary fibrosis and was given two weeks later Her post-therapy scan one week after the 150 mCi of 131I showed uptake just left of the midline in the base of the neck as well as extensive pulmonary uptake of the radioactive iodine The patient did not suffer any complications after her radioiodine
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