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Differentiated Thyroid Carcinoma in Children and Young Adults: Evaluation of Response to Treatment

2005; Lippincott Williams & Wilkins; Volume: 30; Issue: 6 Linguagem: Inglês

10.1097/01.rlu.0000162602.48653.54

1536-0229

Nir Hod, Philippe Hagag, Michal Baumer, Judith Sandbank, Tifha Horne,

Thyroid and Parathyroid Surgery

The aim of this study was to evaluate response to treatment of children and young adults with differentiated thyroid carcinoma (DTC).Thirty-one children and young adults (27 female, 4 male, <25 years) with DTC were treated with radioiodine between 1987 and 2003. All patients had previously undergone total (or near-total) thyroidectomy with lymph node dissection (if enlarged lymph nodes were present). Initial radioiodine therapy was given 4 to 6 weeks after surgery. Repeated doses were given 4 to 6 weeks after l-thyroxine withdrawal. Effect of therapy was evaluated by radioiodine whole-body scans and serum thyroglobulin levels.Age range at diagnosis was 12 to 25 years (median, 21 years). Follow-up duration range was 16 to 150 months (mean, 60 months). Histologic classification was papillary in 28 (90%) patients (follicular variant in 7) and follicular in 3 (10%). Multifocal carcinoma was found in 9 (29%) patients and neck lymph node metastases in 19 (61%) patients. Fifteen (48%) patients had pulmonary or mediastinal metastases at the time of diagnosis, and 1 developed bone metastases. Lung metastases demonstrated a pattern of diffuse radioiodine uptake in 7 patients and focal uptake in 8. Total radioiodine dose range was 80 to 1086 mCi given in 1 to 7 treatments. Fourteen (45%) patients were disease-free, including 1 patient with pulmonary metastases who achieved complete remission. Three (10%) patients had persistent metastases in neck lymph nodes. Nine (29%) patients with pulmonary metastases showed good response, 4 (13%) had stable persistent disease, and 1 had progression of the disease and died after 11.5 years of follow up. All surviving patients (97%) are asymptomatic and leading normal lives.Children and young adults with DTC had a high incidence of multifocal disease, lymph node involvement, and pulmonary metastases. Although complete remission of pulmonary metastases after radioiodine therapy was difficult to achieve, a partial response with reduction of metastatic disease was possible. In general, the patients had a good quality of life with no further disease progression and a low mortality rate.