Treating papillary and follicular thyroid cancer in children and young people: Single UK-center experience between 2003 and 2018.

Published on Mar 1, 2021in Journal of Pediatric Surgery1.919
· DOI :10.1016/J.JPEDSURG.2020.07.034
Mechteld C de Jong1
Estimated H-index: 1
(UCLH: University College London Hospitals NHS Foundation Trust),
Mechteld C. de Jong1
Estimated H-index: 1
(UCLH: University College London Hospitals NHS Foundation Trust)
+ 18 AuthorsTom R. Kurzawinski10
Estimated H-index: 10
(UCLH: University College London Hospitals NHS Foundation Trust)
AIM Differentiated thyroid cancer (DTC) in children and adolescents is rare and data about its presentation and management are not well known. The aim of this study was to provide evidence of the current practice in the United Kingdom before the launch of the Rare National Paediatric Endocrine Tumours Guidelines (to be published in 2020). METHODS Seventy-two children and adolescents with DTC (<18 years) who were treated at our institution between 2003 and 2018 were identified and their presentation, treatment and outcomes were reviewed. RESULTS Median age at presentation was 12.7 years [range: 1-18] and fifty-two (72%) were girls. Fifty (69.4%) children and adolescents presented with a thyroid nodule. Thirteen (18%) had cervical adenopathy and seven of them (54%) underwent an excision biopsy under GA. Eight patients (11%) had evidence of lung metastases at presentation. Twenty-four patients (33%) underwent a hemithyroidectomy and 22 of those had a completion thyroidectomy subsequently, ten (14%) a total thyroidectomy alone and 37 (51%) a total thyroidectomy with lymph nodes dissection. Seventy patients (97%) underwent adjuvant RAI at our institution. The median number of children and adolescents managed per year was five [range: 0-10]. After an overall median follow-up of 40 months, eight patients (11%) had developed recurrent disease. The 1- and 5-year recurrence-free-survival-rates were 93% and 87%, respectively. Overall survival was 100%, with eight children and adolescents (11%) being alive with disease. CONCLUSION This study confirms that DTC in children and adolescents is uncommon, is frequently advanced at presentation and has considerable recurrence rates. Despite this, overall survival is excellent. Although the work-up was generally appropriate (image-guided cytology), open biopsy for the diagnosis of lymph node involvement was still employed. The introduction of a specific UK guideline for this age-group will likely result in more tailored-made treatment-pathways and thereby hopefully improve quality and outcomes even further. TYPE OF STUDY Prognosis study. LEVEL OF EVIDENCE Level IV.
#1Mechteld C. de Jong (UCLH: University College Hospital)H-Index: 1
#1Mechteld C de Jong (UCLH: University College Hospital)H-Index: 1
Last. Tom R Kurzawinski (UCLH: University College Hospital)H-Index: 6
view all 8 authors...
Abstract Purpose Disruption of calcium homeostasis is the most common complication after total thyroidectomy in adults. We explored the incidence and risk factors of hypocalcaemia and hypoparathyroidism after total thyroidectomy in children(≤ 18 years of age). Methods One-hundred-and-six children underwent a total thyroidectomy. Patient, operative and outcome data were collected and analyzed. Results The indication for surgery was Graves' disease in 52 children(49.1%), Multiple Endocrine Neoplas...
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#1Amer Heider (UM: University of Michigan)H-Index: 12
#2Stacy Arnold (UM: University of Michigan)H-Index: 1
Last. Xin Jing (UM: University of Michigan)H-Index: 11
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BACKGROUND: Postoperative hypocalcemia because of hypoparathyroidism is the most common complication of total thyroidectomy in children. We hypothesized that most children with postoperative hypocalcemia would be eucalcemic by 12 mo and sought to define risk factors for permanent hypoparathyroidism. METHODS: We retrospectively reviewed children who underwent total thyroidectomy at a single children's hospital from 2012 to 2019. Patients with prior neck surgery were excluded. Indication for opera...
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Background Hypoparathyroidism occurs relatively frequently after thyroid surgery in children. However, few studies have reported risk factors. We aimed to identify risk factors for hypoparathyroidism that occurred after total thyroidectomy for proven or suspected malignancy in children.
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#1Heron D. Baumgarten (UPenn: University of Pennsylvania)H-Index: 6
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Thyroid cancer in children is rare and accounts for 1–3% of all malignant tumours. Differentiated thyroid cancers (DTC) and particularly papillary thyroid carcinoma (PTC) (90% of cases) are the most prevalent. Surgery is the mainstay of treatment in patients with DTC. The current recommendations are based not on prospective randomised clinical trials, but on retrospective trials and expert opinions. Therefore, it is not easy to choose the optimal therapeutic strategy to obtain the best treatment...
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