Thyroid Microcarcinoma in Pediatric Patients: How Aggressive do we Need to be?

Abstract

In adults, papillary thyroid microcarcinoma (PTMC: tumors ≤1 cm) is now the most common form of thyroid carcinoma [1-4]. In children, TMC is an entity not often discussed since young patients are known to present with more extensive disease and are more often the focus of discussion [5,6]. The good news is that the incidence of PTMC in children is decreasing [7]. Nevertheless, given the potential morbidity from thyroid surgery, the potential need for thyroid suppression during important times of growth and development, and long-term quality of life, the management of PTMCs in children needs to be addressed. There are no guidelines or level I studies on the management of these patients. Our goal as clinicians should be to offer these generally low-risk patients a management strategy with the least morbidity, fewest complications, best long-term cancer control and quality of life. There are two scenarios that lead to the discovery of PTMC: incidental pathological finding when surgery is performed for another reason such as multinodular goiter or Graves’ disease and when a less than 1 cm lesion is discovered through imaging and biopsied preoperatively. Management options arise at the following time points: the decision to biopsy and operate for a less than 1 cm lesion, what operation to perform, the role of radioiodine (RAI) ablation, TSH suppression and long-term surveillance.