CARCINOMA OF THE THYROID IN CHILDREN - A REVIEW

Thyroid cancer is the third most common solid tumor in children and ad olescents. A review was made of the data on 540 such patients reported from nine large centers renowned for their experience with thyroid ca ncer. In respect to the pathogenesis the only factor conclusively know n to promote development of thyroid cancer in the pediatric age group is irradiation, as documented by the Chernobyl experience, The evidenc e indicates that thyroid carcinoma in the pediatric age group is a bio logically independent and more aggressive entity than in adults; parad oxically the prognosis is good, In the great majority of cases the onl y presenting sign was a neck mass, In a high percentage (60-80%) there were also palpable lymph nodes, The findings regarding lung metastase s were not clear-cut: in most series they were present in about 10%, w ith a high of 28% in one group and a low of 5% in another group, Papil lary carcinoma or the follicular variant of papillary carcinoma were t he dominant histologic types, pure follicular carcinoma being found mu ch less frequently than among adults with thyroid cancer, Despite the relatively advanced stage of the disease upon diagnosis, only 13 patie nts died of the disease, 12 to 33 years postoperatively. Recurrence ra tes ranged between 10% to 35%, with involvement of the lateral neck, t hyroidal bed or distant sites 3 to 33 years after treatment; most fail ures responded to further surgery or radioactive iodine, There is almo st general agreement that surgical intervention should consist of tota l or near total thyroidectomy despite the high rates of recurrent lary ngeal nerve paralysis and hypocalcemia, In regard to neck metastases l ess than radical surgery has proved during the years to be sufficientl y effective, Radioactive iodine, used by all at some stage of manageme nt for treatment purposes, should be used prophylactically only after due consideration in view of possible teratogenicity.