engleski

Childhood and Adolescent Thyroid Carcinoma in Comparison with Adult Patients

Evaluation of presentation, therapy and outcome of the thyroid carcinoma (TC) in children and adolescent in comparison with adult patients (pts). 958 pts treated for TC in our department were divided in 4 groups in view of age: 1. Children in pre-puberty period: 9 pts (3-12 years of age) 2.Teenagers/adolescent: 29 pts (12-21 yrs of age) 3.Young and middle aged: 536 pts (22-50 yrs of age) 4.Elderly group: 384 pts (51-80 yrs of age). Mean follow up in the groups was 10, 12, 7 and 5 yrs, respectively. Female/male ratio was 1:1, 1:4, 1:5 and 1:5, respectively. Total thyroidectomy was performed in all children and adolescent, and in 98% of adult pts. Lymph node (LN) dissection was performed in pts with ultrasonically guide fine needle biopsy (UGFNB) diagnosed metastases. Radioiodine ablation of thyroid remnant was performed in 85% of children and adolescent, and in 94% of adult pts. Pts with 131I positive distant metastases (DM) were treated with additional 131I therapies. Papillary carcinoma was found in the groups: 100%, 90%, 82 % and 69%, follicular carcinoma in 0%, 0%, 12% and 19%, Hürthle cell carcinoma in 0%, 0%, 2% and 3%, medullary carcinoma in 0%, 10%, 4%, and 8% of pts, respectively, and anaplastic carcinoma in 1% of the forth group, only. Primary TC < 1 cm was found in the groups: 0%, 8%, 32% and 33%, respectively. Extrathyroid tumour infiltration was found in 56%, 7%, 9% and 19%, multicentric foci in 56%, 30%, 24% and 25%, LN metastases in 67%, 40%, 36% and 29%, and DM in 33%, 7%, 5% and 9% of pts, respectively. During the follow-up period two pts died from the first group, nobody from the second group, 0, 7% of pts died from the third group and 5% from the fourth group. Children and adolescent had advanced disease at the time of initial diagnosis, especially pts younger than 12 yrs of age, what suggest different biological behaviour but also later diagnosis. We suggest more often use of ultrasound examination of the thyroid and the neck in children and adolescent population, UGFNB, total thyroidectomy and LN dissection if TC and LN metastases was diagnosed, and radioiodine ablation of thyroid remnant. Despite an overall good prognosis, it cannot be overemphasized that the survival rates of children with TC as a whole are lower than those of young and middle aged pts.

thyroid carcinoma; childhood; adolescent; adult patients; prognostic factors

DOI: 10.1007/s00259-006-0214-3