THYROID CANCER IN CHILDREN

Thyroid Cancer : In spite of presenting with advanced, multicentric and larger tumors children have a better survival than adults. Populations at risk: past radiation to head and neck, nuclear waste radiation, MEN II kindred. Clinical presentation is a solitary cervical mass or metastatic lymph node. Diagnostic work-up should include: sonogram (cystic or solid), thyroid scan (cold or hot), Fine-needle aspiration cytology(FNA), and Chest-X-Ray (lung metastasis 20% at dx). Pathology of tumors: papillary (majority, psammomas bodies), follicular (vascular or capsular invasion), medullary (arise from C-cells, multicentric, locally invasive), anaplastic (rare, invasive and metastatic).

Management is surgical. Complications of surgery increase with decreasing age of patient: temporary hypoparathyroidism, recurrent nerve injury. Prognostic factors associated to higher mortality are: non-diploid DNA, psammomas bodies, over 2 cm diameter nodule, and anaplastic histology. Follow-up for recurrence with serum thyroglobulin level and radioisotope scans. Adjunctive therapy: thyroid suppression and radio-iodine for lymph nodes and pulmonary metastasis.