Papillary Thyroid Carcinoma in Children: Clinicopathological Profile and Outcomes of Management
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ORIGINAL SCIENTIFIC REPORT
Papillary Thyroid Carcinoma in Children: Clinicopathological Profile and Outcomes of Management John K. Thomas1 • Jujju Jacob Kurian1 • Anish Jacob Cherian2 Deepak Thomas Abraham2
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Julie Hephzibah3 • M. J. Paul2
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Accepted: 5 September 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background We aim to analyze the clinicopathological profile and outcomes of management for children with papillary thyroid carcinoma (PTC). Methods Relevant clinical data of children B 18 years of age managed for PTC between January 2006 and July 2018 as well as details of their follow-up till December 2019 were retrospectively collected and analyzed. Results There were 82 children with PTC that were managed during the study period. At presentation, 39 (47.6%) had cervical lymphadenopathy, while 9 (11%) had systemic metastasis. Majority of patients 39 (47.6%) underwent total thyroidectomy with a selective neck dissection, while total thyroidectomy alone was performed in 26 (31.7%). Following surgery, hypocalcemia was seen in 39 (47.6%): 28 (34.1%) were temporary, while 11 (13.4%) were permanent. Twenty-eight (34%) developed persistent disease after surgery and 131I therapy. Significant risk factors for persistence and metastatic disease were metastatic cervical lymph node at presentation (p = 0.002) and tumor size (p = 0.014), respectively. The mean duration of follow-up was 60.3 (range 12–150) months with a mean overall disease-free survival of 60 months (95% CI 57.11, 77.95). Conclusion Children with papillary thyroid cancers present with aggressive disease, 47.6% with cervical nodal metastasis and 11% with distant metastasis in this cohort. The rate of post-thyroidectomy hypocalcemia in this study is substantial, and efforts to reduce it are actively being pursued. The presence of metastatic cervical lymph node at presentation (p = 0.002) and tumor size (p = 0.014) were the only significant risk factors for persistent and metastatic disease, respectively, in this study.
Palpable thyroid nodules in children are rare with an incidence of 1–2% [1–4]. Though the majority of thyroid nodules in children are benign, they have a fourfold higher & Anish Jacob Cherian [email protected] 1
Dept of Pediatric Surgery, Christian Medical College, Vellore, India
2
Dept of Endocrine Surgery, Christian Medical College and Hospital, Vellore, India
3
Dept of Nuclear Medicine, Christian Medical College, Vellore, India
risk of developing malignancy when compared to adults [5]. Differentiated thyroid carcinoma is the most common pediatric endocrine malignancy (0.5–3% of all childhood malignancies) with papillary thyroid carcinoma (PTC) being the most common type. The SEER registry studies have shown an annual 3% increase in the incidence of differentiated thyroid cancers, the reasons being improved imaging modalities as well as an actual increase in incidence [6, 7]. The clinical course of differentiated thyroid carcinoma in children differs from adults, in that children have higher rates of cervical
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