Pediatric Differentiated Thyroid Carcinoma

Abstract

Differentiated thyroid carcinoma (DTC) is uncommon in the pediatric population but its incidence has been increasing, especially in 15–19 year olds, the most commonly affected age group. Papillary thyroid carcinoma represents 90% or more of cases in children, who typically present with larger tumors, a higher prevalence of regional lymph node disease, and an increased rate of pulmonary metastases compared with adults. Despite more advanced disease, patients with pediatric DTC paradoxically have very low disease-specific mortality, even in the presence of distant metastases at diagnosis. Whenever feasible, children with DTC should be cared for at centers with comprehensive and multidisciplinary thyroid cancer programs. Initial surgery performed by a high-volume thyroid surgeon is the most critical step to improve long-term disease free survival and to limit surgical morbidity. Concerns about late effects, such as secondary malignancies, has prompted reconsideration of universal radioactive iodine (RAI) ablation. Rather, a more conservative approach has evolved, recognizing that patients can take years to respond to previous RAI therapy and also acknowledging that pediatric DTC becomes, not uncommonly, an incurable yet indolent disease. Postoperative staging is used to individualize treatment and recent American Thyroid Association guidelines were created specifically for the management of pediatric DTC. More research needs to be done to better understand the genomics of pediatric DTC and to improve risk-stratification systems to determine who may or may not benefit from more aggressive treatment and postoperative surveillance during childhood.