miércoles, 17 de enero de 2018

Childhood Thyroid Cancer Treatment (PDQ®)–Health Professional Version

Childhood Thyroid Cancer Treatment (PDQ®)—Health Professional Version - National Cancer Institute
National Cancer Institute

Childhood Thyroid Cancer Treatment (PDQ®)–Health Professional Version


Diagnostic Evaluation

Initial evaluation of a child or adolescent with a thyroid nodule includes the following:
  • Ultrasound of the thyroid.
  • Serum thyroid-stimulating hormone (TSH) level.
  • Serum thyroglobulin level.
Tests of thyroid function are usually normal, but thyroglobulin can be elevated.
Fine-needle aspiration as an initial diagnostic approach is sensitive and useful. However, in doubtful cases, open biopsy or resection should be considered.[1-4] Open biopsy or resection may also be preferable for young children (refer to Table 2).
Table 2. Thyroid Carcinomas in Children
HistologyAssociated Chromosomal AbnormalityPresentationDiagnosisTreatment
EGF = epidermal growth factor; 131I = iodine I 131; MEN2 = multiple endocrine neoplasia type 2; TSH = thyroid-stimulating hormone.
Differentiated thyroid carcinomaRET/PTC more common in children. BRAFV600E mutations occur with similar frequency in children and adults. Association with rare hereditary tumor syndromes: APC-associated polyposis, DICER1syndrome, Carney complex, PTENhamartoma tumor syndrome, Werner syndrome.Thyroid mass. Prepubertal children more often with nodal and lung metastases.Ultrasound, TSH, thyroglobulin. Fine needle or open biopsy.Total or near-total thyroidectomy; 131I; thyroid hormone. In metastatic or recurrent disease, tyrosine kinase or EGF receptor inhibitors may be of benefit.
Medullary thyroid carcinomaMEN2Aggressive. 50% with metastases at presentation.In familial MEN2, RETtesting.Aggressive surgical intervention. Prophylactic thyroidectomy is indicated in familial cases.
  1. Willgerodt H, Keller E, Bennek J, et al.: Diagnostic value of fine-needle aspiration biopsy of thyroid nodules in children and adolescents. J Pediatr Endocrinol Metab 19 (4): 507-15, 2006. [PUBMED Abstract]
  2. Stevens C, Lee JK, Sadatsafavi M, et al.: Pediatric thyroid fine-needle aspiration cytology: a meta-analysis. J Pediatr Surg 44 (11): 2184-91, 2009. [PUBMED Abstract]
  3. Bargren AE, Meyer-Rochow GY, Sywak MS, et al.: Diagnostic utility of fine-needle aspiration cytology in pediatric differentiated thyroid cancer. World J Surg 34 (6): 1254-60, 2010. [PUBMED Abstract]
  4. Redlich A, Boxberger N, Kurt Werner S, et al.: Sensitivity of fine-needle biopsy in detecting pediatric differentiated thyroid carcinoma. Pediatr Blood Cancer 59 (2): 233-7, 2012. [PUBMED Abstract]
  • Updated: January 9, 2018

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