Invited Commentary: Clinical Assessment of Pediatric Patients with Differentiated Thyroid Carcinoma: A 30-Year Experienc
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INVITED COMMENTARY
Invited Commentary: Clinical Assessment of Pediatric Patients with Differentiated Thyroid Carcinoma: A 30-Year Experience at the Single Institution Danielle Ellis1 • Tamara N. Fitzgerald2,3
Ó Socie´te´ Internationale de Chirurgie 2020
Differentiated thyroid cancer (papillary, follicular and Hurthle cell carcinoma; DTC) occurs less frequently in children compared to adults, and previously, treatment for pediatric DTC has followed adult guidelines. In 2015, the American Thyroid Association (ATA) released guidelines for the management of thyroid nodules and DTC in children, recognizing that children have differences in disease presentation, treatment goals and need for long-term follow up [1]. The management of DTC in children is subsequently evolving. Definitive therapy for pediatric DTC includes surgical resection and possible radiotherapy with I-131, but controversy exists regarding the optimal treatment strategy in children. Children often present with more advanced disease at diagnosis and have greater life-years remaining after treatment. Therefore, current ATA guidelines recommend total thyroidectomy for all DTC and I-131 radiotherapy for advanced disease [1]. However, children can have a higher rate of complications after thyroidectomy and are more susceptible to the long-term effects of radiation, which would support less aggressive treatment. For this reason, some advocate for partial thyroidectomy (lobectomy) as a treatment option. Partial thyroidectomy decreases the risk of hypoparathyroidism and injury to the recurrent laryngeal nerves, although these risks can be decreased by employing a high-volume endocrine surgeon.
& Tamara N. Fitzgerald [email protected] 1
University of North Carolina School of Medicine, Chapel Hill, NC, USA
2
Department of Surgery, Duke University School of Medicine, Durham, NC, USA
3
Duke Global Health Institute, Durham, NC, USA
Partial thyroidectomy may also allow the patient to remain euthyroid without levothyroxine supplementation. However, the risk of cancer recurrence is higher when partial thyroidectomy is performed [2]. After partial thyroidectomy, radioiodine scanning cannot be used to assess for residual disease, I-131 radiotherapy cannot be given, thyroid stimulating hormone (TSH) cannot be suppressed, and thyroglobulin levels cannot be measured to monitor recurrence. Thus, the recommended extent of surgery remains controversial. In the current analysis, Kim and colleagues provide a 30-year retrospective analysis of their experience with partial and total thyroidectomy in pediatric patients. They found that tumor size [2 cm and the presence of positive lymph nodes were predictors of recurrence. Readers should focus on Table 2 and Fig. 1, and Table 5 and Fig. 2 for a comparison of clinicopathologic characteristics and disease-free survival according to tumor size and surgical method, respectively. Table 2 and Fig. 1 demonstrate that in this cohort, tumor size [ 2 cm was associated with increased recurrence and lower diseasefree survival. Conve
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