Clinical features of differentiated thyroid carcinoma in children and adolescents front a sub-Himalayan iodine-deficient endemic zone

Northern India is an identified sub-Himalayan iodine-deficient endemic zone . We retrospectively analysed the case files of children with differentiate d thyroid carcinoma from this endemic zone and attempted to define the dise ase in terms of its presentation, clinical course and outcome of radioiodin e therapy. Between 1967 and June 2000, 1135 patients with thyroid cancer we re treated in our centre and 80 (7%) were less than 20 years of age. There were 45 females and 35 males. Histologically, 85% of patients had papillary carcinoma and the rest follicular carcinoma. Cervical lymph node involveme nt was seen in 66% of patients, and distant metastasis, mainly pulmonary, i n 29%. In children less than 10 years of age, 75% of patients had distant m etastasis at the time of presentation. The post-surgery 48 h radioiodine ne ck uptake was 12.2 +/-9.6%. Ninety-six per cent of the residual thyroid, 90 % of nodal metastases and 57% of pulmonary metastases were ablated. Althoug h nine patients had nodal recurrence between surgery and radioiodine treatm ent, no recurrence was observed thereafter, and three disease-related death s (all in children less than 10 years of age) were seen in the mean follow- up of 6 years. We conclude that, except for the relatively higher incidence of follicular thyroid cancer and the higher mortality in the less than 10 year age group, the course and outcome of differentiated thyroid carcinoma in children from iodine-deficient areas is no different from that in childr en in iodine-sufficient areas. ((C) 2001 Lippincott Williams & Wilkins).