Endocrine Abstracts (2006) 11 P475

Management of thyroid cancer in children

A Mazilu, AE Ranetti, A Mihai & C Spiroiu

University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania.

The purpose of the study was to assess the peculiarities of diagnostic and treatment of thyroid cancer in children.

Material and method: Between 2000–2005 we screened 234 patients age 3–18 years that presented for various complaints suggesting possible thyroid disease (thyroid enlargement, dysphonia, dysphagia, delayed growth). They were submitted to clinical examination, ultrasonography, T4 and TSH test. The solitary nodules and polinodular goiters performed 99Tc-pertechnetate scintigraphy and in suspicious cases FNAB.

Results: 8 of these patients were diagnosed with cancer on histopathological exam (75% papillary cancer, 12.5% medullar carcinoma, 12.5% follicular carcinoma). 1 patient aged 3 years and a mother diagnosed with MEN2b syndrome, had slightly elevated calcitonin levels. The extemporaneous pathological exam showed multiple foci of medullar carcinoma and lymph node invasion. We decided to perform total thyroidectomy and cervical dissection. From the 6 cases of papillary carcinoma, 2 were diagnosed in 2002 and 3 in 2003(aged 2, respective 1 year in 1986, suggesting possible relation to Chernobyl disaster). From 6 cases of papillary carcinoma 66% had lymph node metastases and 16.6% had pulmonary metastases. All these cases benefit from near-total thyroidectomy. 131I therapy was used for recurrent local disease (1 case) and for pulmonary metastases.

Conclusions: The distribution of histopatological types was similar to that of adults.

The near total thyroidectomy with cervical dissection was the intervention practiced in most cases.

The patient needs to be reevaluated once a year by ultrasonography, 131I scintigraphy, thyreoglobuline levels for detection of residual/recurrent disease and metastases. All the patients survived until now without secondary side effects of 131I therapy or severe surgical complication (only one transient hypoparathyroidism).

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