PRIMARY THYROID-CARCINOMA IN CHILDREN - A RETROSPECTIVE STUDY OF 20 PATIENTS

A total of 20 children (median age 11 years) were treated for primary thyroid carcinoma from 1976 to 1990. Papillary adenocarcinoma was diag nosed in 19 and follicular in one case. Nineteen of 20 patients were c onsidered amenable to surgery, which consisted of total thyroidectomy in 14 and partial thyroidectomy in 5. Only one patient with extensive perithyroid soft tissue infiltration was treated with external beam ra diotherapy. Monolateral or bilateral cervical nodal dissection was per formed in eight and six children, respectively; in nine cases without clinical evidence of metastatic nodes. Pathological examination showed that tumor extent was greater than that clinically assessed: Multiple tumor foci within the thyroid were assessed in 8/19, unilateral posit ive nodes in 8, and bilateral in 6, and soft tissue infiltration in 7. Subsequently 10 patients received thyroid-stimulating hormone (TSH) s uppressive hormonotherapy. Relapses occurred in 7/20 at 2-48 months (m edian 18) from primary treatment: Four in cervical nodes, two in cervi cal nodes and lungs, and one in lungs. These seven patients were salva ged with node dissection and radioiodine therapy for lung metastases. All the 20 children are alive and disease-free after a median follow-u p of longer than 10 years. The incidence of relapse was greater in the group of patients not given TSH-suppressive hormonotherapy. Total thy roidectomy produced permanent hypoparathyroidism in 5/14 (36%). Thyroi d carcinoma in children of this series frequently presented with multi ple tumor foci within the thyroid and cervical node metastases. Progno sis was favourable even after relapse and was not related to the exten t of surgical treatment. Limited surgery and suppressive hormonotherap y may be adequate therapy for thyroid carcinoma in children. (C) 1995 Wiley-Liss, Inc.