Thyroid Cancer In Adolescents Research Articles

Long-term oncological outcomes of follicular thyroid cancer in adolescents and young adults: A nationwide population-based study.

Follicular thyroid carcinoma (FTC) in adolescents and young adults (AYAs) is rare and data on long-term oncological outcomes are scarce. This study aimed to describe the long-term recurrence and survival rates of AYAs with FTC, and identify risk factors for recurrence. This is a retrospective cohort study combining two national databases, including all patients aged 15-39years, diagnosed with FTC in The Netherlands between 2000 and 2016. Age, sex, tumor size, focality, positive margins, angioinvasion, pT-stage, and pN-stage were included in a Cox proportional hazard model to identify risk factors for recurrence. We included 192 patients. Median age was 31.0years (IQR 24.7-36.3) and the male to female ratio was 1:4.1. Most patients presented with a minimally invasive FTC (MI-FTC) (95%). Five patients presented with synchronous metastases (2.6%), including two with locoregional metastases (1%) and three with distant metastases (1.6%). During a median follow-up of 12.0years, three patients developed a recurrence (1.6%), of which one patient developed a local recurrence (33%), and two patients a distant recurrence (67%). Five patients died during follow-up (2.6%). Cause of death was not captured. A Cox proportional hazard model could not be performed due to the low number of recurrences. FTC in AYAs is generally characterized as a low-risk tumor, as it exhibits a very low recurrence rate, a high overall survival, and it typically presents as MI-FTC without synchronous metastases. These findings underscore the favorable long-term oncological prognosis of FTC in AYAs.

The clinical and histopathological characteristics of thyroid gland diseases in adolescents requiring surgical treatment: a ten-year follow-up study.

The present research aimed to determine the clinical and pathohistological characteristics of thyroid gland diseases in adolescents who were previously surgically treated at the Endocrine Surgery Center of the University Medical Center of Serbia from 01/01/2001 to 01/01/2011. The study covered 170 patients of both sexes from the population of adolescents (aged 16 to 20 years) with various malignant and benign thyroid gland diseases. The data for this study were extracted from the medical histories of patients and the electronic database of the Center for Endocrine Surgery. Detailed data analysis included diagnosis, symptomatology, surgical intervention type, and disease stage. The following thyroid status parameters were analyzed from preoperative data: thyroxine (T4), thyroxine free fraction (FT4), triiodothyronine (T3), triiodothyronine free fraction (FT3), and thyroid stimulating hormone (TSH). In addition, the pathohistological features of diagnosed thyroid diseases were also determined, with a special focus on the presence of well-differentiated cancers. Papillary carcinomas were the most common of well-differentiated cancers in adolescents over the ten-year follow-up period. Based on the assessed data, total thyroidectomy was the most commonly used type of surgical intervention in these patients. The conducted research provides essential information related to both the biological characteristics and diagnostics of these cancers and their surgical treatment in such a sensitive population. Moreover, research showed that the clinical presentation of thyroid cancer in adolescents is almost identical to that in adults.

Differentiated Thyroid Cancer in Adolescents: Single Center Experience and Considerations for Surgical Management and Radioiodine Treatment

Differentiated thyroid cancer (DTC) in adolescents rare but with a favorable outcome, despite higher rates of cervical lymph node and pulmonary metastasis compared to adults. The aim of this study was to critically evaluate treatment of adolescents with DTC at a single center. Patients receiving postoperative radioiodine treatment (RAIT) for DTC between 2005 and 2020 at our institution were screened to identify adolescents according to the World Health Organization definition (10-19 years of age). Demographics, clinico-pathological characteristics, treatment and outcome were analyzed. Among 1,897 DTC patients, 23 (1.3%) were adolescents with a median (range) age of 16 (10-18) years. The female to male ratio was 3.6:1. Sixty percent had classic papillary thyroid cancer, with follicular variant in 40%, which was higher than previously reported (15-25%) for this age group. pT-status was pT1 in 9 (39.2%), pT2 in 8 (34.8%), pT3 in 3 (13%) and pT4 in 3 (13%) patients. In 19 (82.6%) patients, central lymphadenectomy was performed and metastasis was seen in 57%. All patients received RAIT with initial activities of 1.2 (n=1, 4.3%), 2 (n=12, 52.2%) or 3.7 GBq (n=10, 43.5%). Eighteen (78.2%) patients were free of biochemical and radiologic disease at a median follow-up of 60.7 months. Second-line surgery for lymph node relapse was necessary in 3 (13%) cases. There was one disease-associated death. Despite high rates of metastasis, most patients were cured, and second-line surgery was rarely required. Further prospective studies are needed to determine whether less aggressive surgical management or omitting adjuvant RAIT are feasible in patients with limited stages at diagnosis.

Thyroid Cancer in Adolescents and Young Adults

Thyroid Cancer in Adolescents and Young Adults

Survivorship, Quality of Life, and Transition to Adult Care for Pediatric and Adolescent Thyroid Cancer Survivors.

The importance of long-term survivorship care to reduce survivor and family anxiety and burden, decrease emergency visits and health care costs, improve knowledge, as well as implement timely surveillance is widely accepted. Most childhood cancer survivors suffer from an increased number of medical and psychosocial comorbidities as they age and are at a higher risk for early mortality, which differs by cancer diagnosis. Childhood thyroid cancer survivors fall within this spectrum. Some have significant complications and/or late effects from treatment, whereas others have no long-term medical late effects, but almost all will require life-long thyroid hormone replacement therapy. Therefore, providing survivorship and transitional care, including a survivorship and/or transitional care plan (SCP/TCP), as well as periodically assessing the needs and quality of life for the patient and their family, should be implemented for our young thyroid cancer survivors.

Individual Dose Response and Radiation Origin of Childhood and Adolescent Thyroid Cancer in Fukushima II: Possibility of High I-131 Exposure as in Chernobyl

Background: Thyroid cancer incidence of individual dose groups in Fukushima residents exposed at ≤18 years of age demonstrated a linear response to thyroid dose estimated in the United Nations Scientific Committee on the effects of Atomic Radiation (UNSCEAR) 2020/2021. Increased childhood thyroid cancer in Fukushima was found to come dominantly from radiation exposure from the nuclear accident. The UNSCEAR 2020/2021 concluded that the apparent excess of thyroid cancers would not be expected at thyroid doses estimated by the UNSCEAR. The purpose of this paper is to solve the puzzle of the high childhood thyroid cancer incidence in Fukushima despite the estimated low thyroid dose. Methods: The conversion coefficient k connecting thyroid doses estimated in UNSCEAR 2020/2021 and doses based on direct thyroid dose measurements in Chernobyl: 1 GyUN2021 = k × 1 Gy (gray), was estimated by comparing incidences and dose dependences of thyroid cancers in Fukushima and Chernobyl after nuclear disasters. Results: The ratio of the observed cases /expected cases from cancer registry: of about 60 in Fukushima prefecture, was higher than the ratios observed after the Chernobyl accident. The thyroid doses estimated by UNSCEAR were corrected by adding a baseline dose to recover the severely underestimated ingestion dose. The conversion coefficients were: k =60~70 from the comparison of the excess absolute risks (EAR) and their dose dependences in Fukushima and in Chernobyl, and k =10~180 from the comparison of excess relative risk per gray (ERR/Gy) in Fukushima with those in Chernobyl. The thyroid doses might have been underestimated by about 1/50~1/100 in UNSCEAR 2020/2021. Conclusion: The dozens-fold increase of childhood thyroid cancer cases after the Fukushima nuclear accident was found to arise from radioactive iodine exposure comparable to that in Chernobyl.

Individual Dose Response and Radiation Origin of Childhood and Adolescent Thyroid Cancer in Fukushima, Japan

Background: After the Fukushima Nuclear Power Plant accident in 2011, thyroid ultrasound screening was carried out as part of the Fukushima health management survey (FHMS) on all residents of ages≤18 years at the accident. The results of the 1st (2011-2013) and 2nd (2014-2015) round screening showed dozens of times excess thyroid cancer detection compared to the expected from the cancer registry. Both FHMS and the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) summarized that thyroid cancer cases detected in Fukushima were unlikely to be attributed to radiation exposure from the absence of dose-response relation. We elucidated the response of thyroid cancer incidence to individual external doses and found the dominant radiation effect on the increased thyroid cancer incidence after the accident. Method: Association between average individual external dose based on FHMS basic survey and thyroid cancer incidence rate of dose groups was analysed by the linear regression analysis. Thyroid dose estimated in UNSCEAR 2020/2021 for 10-year-old children was used for comparison. Results: Incidence proportions of dose groups in the 2nd round showed a linear response to mean individual external dose under 2.5 mSv range. A rough estimate of the excess relative risk per gray (Gy) was ERR/Gy =213 (95%CI: 129, 297) (p=0.02). Conclusion: Childhood and adolescent thyroid cancer in Fukushima was associated with individual external dose estimated in FHMS basic survey. Increased childhood and adolescent thyroid cancer in Fukushima could most probably be attributed to radiation exposure from the nuclear accident.

About the childhood and adolescent thyroid cancer found in Fukushima

About the childhood and adolescent thyroid cancer found in Fukushima

AACE2021-A-1098: Clinical and Pathological Characteristics of Thyroid Cancer in Adolescents and Young Adults (AYA): An Algerian Observation

We aim to describe clinical and pathological characteristics of thyroid cancer in an Algerian cohort of adolescents and adults patients. Medical records of patients followed in the endocrinology department of Constantine University Hospital during the period between July 2014 and December 2018 were retrospectively reviewed. Patients were subdivided into two age groups: < 30 (Group 1) and ≥ 40 years old (Group 2). Thyroid function, type of initial surgery, lymph node dissection, and histological findings were collected. 101 patients were included, the mean age was 31 (17- 40 years), 30.17% were aged <30 years and 85.1% were females. Diagnosis circumstances were multinodular goiter and unique thyroid nodule in 57.4% ,27.7% respectively and 12% had abnormal TSH at the moment of diagnosis. As the initial surgery, total thyroidectomy was done in 88.1% and lymph node dissection in 23.8% which was central in 13.9%, and central and lateral in 9.9%. 90.1% were papillary thyroid cancer, 7.9% (8 patients) were follicular carcinoma and 2 patients had Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Following the 8th AJCC classification,64% were T1, 12.9% T2, and 20.8% were T3 . Microcarcinoma represented 39.6% of cases, and 15.8% had lymph node involvement, while 1 patient had distance metastasis. Multifocality, bilaterality, vascular invasion, and capsular thyroid invasion were seen in 30.7%,15.8%,7.9%, and 17.8% respectively. As for risk stratification according to the American thyroid association (ATA) system, the initial risk was low, intermediate, and high in 41.6%,35.6%, and 10.9% respectively and data were insufficient for risk stratification in 11.9% of patients. 99% were stage I TNM and RAI therapy was done in 88.1% of patients. In analysis AYA patients aged >30 had more capsular invasion and lymph node involvement (p<0.05), and AYA patients with follicular thyroid carcinoma had more thyroid capsular invasion (p<0.05). These data give us a profile of AYA patients in the Algerian population. In our study, patients with follicular carcinoma had more capsular invasion and patients aged< 30 years had more capsular invasion and lymph node involvement.

Increasing incidence and survival of paediatric and adolescent thyroid cancer in Cyprus 1998–2017: A population-based study from the Cyprus Pediatric Oncology Registry

BackgroundPaediatric and adolescent thyroid cancer incidence rates are increasing in many countries. We determined incidence rates, temporal trends and survival from thyroid cancer diagnosed in childhood and adolescence in Cyprus during 1998−2017. MethodsPatients aged 0–19 years, diagnosed with thyroid cancer in the Pediatric Oncology Registry of Cyprus were included. Crude incidence rates, age standardized rates, time trends and overall survival were analysed. Annual rates and temporal trends were calculated using Microsoft Excel 2016 and Joinpoint regression analysis. ResultsEighty-one cases (76.5 % female, 23.5 % male) were identified. The crude rates (per 100,000 persons) were for both sexes 2.00 (95 % CI 1.61, 2.49), females 3.15 (95 % CI 2.45, 4.03) and males 0.92 (95 % CI 0.58, 1.44). The annual percentage changes of crude and standardised rates were 7.5 % (p < 0.05) and 7.6 % (p < 0.05). The annual percentage changes of crude rates were for females 5.1 % (p = 0.1), males 8.4 % (p < 0.05) and 15−19-year-olds 7.6 % (p < 0.05). The female to male rate ratio was 3.42 (95 % CI 2.06, 5.74). Papillary thyroid carcinoma represented 86.4 % of all cases. There was only one case after previous cancer therapy. The rate ratio of 2nd (2008−2017) to 1st (1998−2007) periods for metastatic (regional) stages was 3.76 (95 % CI 1.74, 8.31). Survival until 2018 was 100 %. ConclusionThis population-based study demonstrated that thyroid cancer incidence rates in 0–19-year-olds in Cyprus was among the world’s highest. Increasing trends mainly affected males and females aged 15−19 years with papillary thyroid carcinoma, the dominant type. Cases after previous cancer therapy didn’t contribute to increasing rates. The increase of metastatic cases suggests a true increase of thyroid cancer rather than overdiagnosis. Although prognosis is excellent with 100 % survival, the rising incidence rate is unexplained, indicating the need to identify causes.

Clinical and pathological features of thyroid cancer in adolescents and young adults

Clinical and pathological features of thyroid cancer in adolescents and young adults

Clinical and pathological features of thyroid cancer in adolescents and young adults

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Papillary thyroid cancer in adolescents after neuroblastoma in childhood: Description of the two cases

Papillary thyroid cancer in adolescents after neuroblastoma in childhood: Description of the two cases

Papillary thyroid cancer in adolescents after neuroblastoma in childhood: Description of the two cases

Papillary thyroid cancer in adolescents after neuroblastoma in childhood: Description of the two cases

Papillary thyroid cancer in adolescents after neuroblastoma in childhood: Description of the two cases

Papillary thyroid cancer in adolescents after neuroblastoma in childhood: Description of the two cases

Clinical and pathological features of thyroid cancer in adolescents and young adults

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Clinical Characteristics of Pediatric &amp; Adolescent Thyroid Cancer: A Single Institution Experience of 20 Years

Clinical Characteristics of Pediatric &amp; Adolescent Thyroid Cancer: A Single Institution Experience of 20 Years

Change of Age Distribution of Childhood and Adolescent Thyroid Cancer after the Fukushima Nuclear Accident Compared with the Chernobyl Cases

Background and Methods: Comparison of age patterns of childhood and adolescent childhood thyroid cancer after the nuclear accidents in Fukushima and Chernobyl is often used as a criterion of radiationinduced thyroid cancer in Fukushima. The Fukushima Health Management Survey reports that thyroid cancers in Fukushima are unlikely to be radiation-induced, and one reason for the conclusion was no case was found in the age of 0-5 years at exposure. Published data on the health effects of the Chernobyl accident were analysed to assess whether there was one age pattern common in Chernobyl to be used as a criterion of radiation-induced thyroid cancer. Various age distributions of thyroid cancer as to the age at exposure and age at diagnosis, which depend on the country and the extent of radiation contamination, were studied as a function of years after exposure. Results and Conclusion: The highest incidence of thyroid cancer for infants aged 0-4 at exposure was observed only in Belarus. The high incidence of age group 0-4 AE became apparent only after 12 years from the accident in Ukraine and Russia. Age distribution of diagnosed or suspected thyroid cancer cases in Fukushima by age at exposure shifts to younger age side, average age from 14.9 to 8.3 years in 9 years after the accident. This trend agrees with the one in Ukraine and Russia. Because there is no common age pattern in Chernobyl, we should better not use age pattern as a simple criterion of radiation-induced thyroid cancer.

Factors Influencing the Proportion of Non-examinees in the Fukushima Health Management Survey for Childhood and Adolescent Thyroid Cancer: Results From the Baseline Survey.

BackgroundAfter the Fukushima Daiichi Nuclear Power Plant accident, a preliminary ultrasound-based screening for thyroid cancer was conducted to establish a baseline for subsequent evaluations. In this survey, we assessed the relationship between the proportion of non-examinees and characteristics of the target populations.MethodsAfter summarizing a regional difference of non-examinees among the population of 359,200 (primary evaluation) and 2,246 (confirmatory testing) individuals who were living in Fukushima Prefecture on March 11, 2011, we estimated odds ratios (ORs) for each characteristic, including age, sex, area of residence, and moving after the accident, based on the proportion of non-examinees for the primary examination and the confirmatory testing, using a multivariate logistic regression model.ResultsThe dataset included 64,117 non-examinees (primary evaluation) and 194 (confirmatory testing). The logistic regression result indicated that girls were not likely to be non-examinees compared to boys, with adjusted OR of 0.80 (95% confidence interval [CI], 0.78–0.81) for the primary evaluation. Odds were lowest for children 6–10 years old (OR 0.26; 95% CI, 0.25–0.27), and higher for those 11–15 years old (OR 1.28; 95% CI, 1.25–1.32) and over 16 years old (OR 5.30; 95% CI, 5.16–5.43) when compared to children 0–5 years old. Individuals residing in the western part of the prefecture showed higher ORs. There was a higher proportion of non-examinees among those who moved after the accident compared to those who did not in the primary evaluation (OR 1.72; 95% CI, 1.64–1.79).ConclusionsIn addition to demographic characteristics, a change of residence could be a potential factor that influenced the proportion of non-examinees. Our results will help proper interpretation of reports and prospective management of the survey.

MON-508 Clinicopathological Features of Papillary Thyroid Cancer After Fukushima and Chernobyl Accidents

The phenomenon of a sharp increase in the incidence of thyroid cancer worldwide is now under debate. Screening activity, diagnostic improvements or real rise in incidence as a result of unknown carcinogens are discussed. Studies in Belarus after Chernobyl showed that the synergistic influence of radiation and nitrates might lead to an increased thyroid cancer (TC) risk in children. For better understanding of the etiology, we compared the published clinical data of pediatric TC patients after the nuclear emergency of Fukushima with the observations we made after the Chernobyl accident.In a large-scale survey after the Fukushima accident, 300,476 subjects were screened and by September 2018, 191 subjects were diagnosed with thyroid malignancy or suspected malignancy by fine needle aspiration. Mean age of TC patients was 17.8 years at presentation. Mean tumor size was 14.9 mm. Postoperative lymph node metastasis, extra-thyroidal invasion, and pulmonary metastasis were detected in 79%, 45%, and 2.1% of all cases, respectively. Only 4.8% TC cases were staged as low risk pT1aN0M0 (Suzuki et al. 2018). For comparison, in Belarus patients mean age was 13.0 years at presentation (1078 cases), mean tumor size 14.4 mm. Lymph node metastases were observed in 74%, pulmonary metastasis in 11% and extra-thyroidal extension in 48.5 - 64.1% (with respect to latency period). The low risk (pT1aN0M0) TC patients were diagnosed in 19.2% cases.The most of TC cases from Japan and Belarus were clinically significant, not “overdiagnosed” and screened on time. Given that the accidental thyroid doses were very low in Japanese cases, it would be very important to evaluate and compare the exposure to endocrine disruptors as e.g. nitrates and low radiation doses from diagnostic procedures (dental X-ray examination and computed tomography).Referece:Suzuki S, Matsumoto Y, Ookouchi C, Nakano K, Iwadate M, Suzuki S, Nakamura I, Fukushima T, Mizunuma H, Yamashita S, Takenoshita S. The clinicopathological features of childhood and adolescent thyroid cancer in Fukushima after the Fukushima Daiichi nuclear power plant accident. Thyroid. 2018; Supplement 1, (Poster 136).