Differences between pediatric and adult treatment protocols in differentiated thyroid carcinoma: need for transitional guidelines for adolescents

Sarah Clement; Teske Kroondijk; Treijen Mark van; Santen Hanneke van

doi:10.1530/endoabs.110.P1142

JOINT3163

Introduction: The presentation and outcome of differentiated thyroid carcinoma (DTC) differ significantly between pediatric and adult patients, leading to distinct guidelines for each group. Adolescents may receive different treatment on either pediatric or adult protocols, raising the question whether this distinction is justified or if a dedicated guideline for adolescents is needed. A critical first step in addressing this issue is a systematic comparison of pediatric and adult DTC guidelines to identify key differences.

Methods: A national review of Dutch pediatric (2020)¹ and adult (2024)² DTC guidelines was conducted, categorizing differences as concordant, discordant or partially concordant.

Results: Of the recommendations in both guidelines, 32% are concordant, 47% are discordant, and 21% are partially concordant. The main difference is a more de-escalating approach to managing adult DTC patients, guided by a validated risk classification system. In contrast, no such validated risk classification system exists for pediatric DTC patients. For pediatric cases, total thyroidectomy followed by radioactive iodine treatment is recommended for all patients with tumors >1 cm. In adults, this approach is clearly indicated only for high-risk DTC patients.

Table 1. Overview of the management of DTC in a 17-year old- vs 18-year old patient.
2 cm tumor and no signs of lymph node or distant metastasis
Age:	17 years old	18 years old
Surgery:	Total thyroidectomy Thyroid hormone replacement therapy	Hemithyroidectomy Categorized as low risk
RAI therapy:	Yes	No
TSH level:	0.5-1.0 mU/l	0.5-2.0 mU/l
Re-stratification	No	Yes, one year after initial treatment
		Excellent response: TSH level normal reference
Abbreviations: RAI: Radioactive iodine; TSH: Thyroid stimulating hormone.

Conclusions: The management of DTC differs significantly between pediatric and adult patients, which can result in adolescents receiving vastly different treatment strategies depending on whether they are classified under pediatric or adult protocol at diagnosis. Relying solely on age may not be appropriate, as other factors beyond age are increasingly recognized to play a critical role in determining the most appropriate treatment strategy. The next step is to collaborate with a multidisciplinary team to develop evidence-based guidelines for adolescents (15-25 years), identify research gaps, and plan further studies to develop tailored recommendations for more personalized treatment strategies.

References: 1. Dutch Society for Endocrinology & Dutch Society for Pediatrics. (2020). Guideline for the treatment of thyroid carcinoma in children. Netherlands Comprehensive Cancer Organisation (IKNL). https://iknl.nl.

2. Dutch Society for Endocrinology & Dutch Society for Surgery. (2024). Guideline thyroid carcinoma. Dutch Guideline Database. https://richtlijnendatabase.nl.

Endocrine Abstracts

P1142