THYROID-CARCINOMA IN CHILDHOOD - MANAGEMENT AND FOLLOW-UP OF 11 CASES

Eleven patients under 16 years of age, 5 males and 6 females were diag nosed with thyroid carcinoma in our hospital between 1974 and 1992. Me dian age at diagnosis was 9.5 years (range: 5.2-15.7 years). The prese nting sign was a single thyroid nodule in 5, multiple thyroid nodules in 1, cervical adenopathy in 3, and thyroid nodules in conjunction wit h cervical adenopathy in 2 patients. Histological diagnosis was papill ary carcinoma in 5 cases, follicular carcinoma in 2, mixed papillary-f ollicular carcinoma in 3, and anaplastic carcinoma in one. Only 4 pati ents had no extrathyroidal metastases at diagnosis. All but one subjec ts underwent total thyroidectomy, either one-staged or two-staged. If metastases were present, ablative radio-iodine therapy followed. Two p atients died within a few months, one from complications of lung metas tases, another from diffuse spread of anaplastic carcinoma. Two patien ts were lost to follow up; 7 patients have been followed for 9.0-18.0 years. Of these, one patient with initial lung metastases has had six recurrences which were success fully treated each time with radio-iodi ne although thyroglobulin levels remained elevated; another patient wh o had an initial subtotal thyroidectomy incurred a relapse 12 years la ter during pregnancy but is doing well now after more intensive surger y. We propose that children with differentiated thyroid carcinoma shou ld undergo total thyroidectomy and selective lymph node extirpation by a skilled surgeon followed by whole body radio-iodine scan and ablati ve radio-iodine treatment if necessary. Plasma thyroglobulin can then be used as a tumour marker and suppressive levothyroxine does should b e given.