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Thyroid carcinoma in children, adolescents and adults, both spontaneous and after childhood radiation exposure

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Abstract

Thyroid carcinoma is the most common second malignancy for childhood cancer survivors. Radiation exposure is linked to risk. Thyroid nodules in children have a high risk for malignancy, whether spontaneous or after radiation. Due to the extremely limited available paediatric data, we sought to review a series of patients with thyroid carcinoma, seen over 25 years. Forty-six patients were identified. Thirty-nine (84.8 %) had papillary thyroid carcinoma, five (10.9 %) follicular carcinoma and 2 (4.3 %) medullary thyroid carcinoma (MEN2B). Thirty-three (71.7 %) had childhood radiation exposure (17 females) with thyroid malignancy occurring 6–37 years later. The smallest nodule size found on surveillance to have thyroid malignancy was 4 mm. Thyroid cancer in patients 16 years and under was seen in 22 patients (47.8 %). All had total thyroidectomy, with initial central node clearance from 2005. Diagnostic rTSH stimulated I123 scan was followed by ablative I131 if any uptake was seen. Sixteen (32.6 %) had metastases. Twenty-four (52.2 %) had I131, four requiring multiple courses. Forty-two remain alive and well.

Conclusion: Ultrasound screening is required for early diagnosis as small nodule size is not predictive of benign histology or absence of metastases. Central node clearance provides better outcome. Despite metastatic disease at presentation for some, prognosis is favourable.

What is Known:

• Incidence of thyroid cancer has been increasing and radiation exposure in childhood cancer survivors is clearly linked to risk.

• Published guidelines in many places can only provide very low level evidence due to extremely limited available paediatric data.

What is New:

• Paper provides good evidence to confirm existing views with the largest cohort of thyroid cancer reported to date in the paediatric age group in Australia, and the largest cohort in Australia where there have been specific high risks of radiation exposure. The only other reported larger studies have come from the Children’s Oncology Group and Childhood Cancer Survivor Study [24].

• Using diagnostic rTSH stimulated I123 scan 6 weeks after surgery helps to determine if radioactive iodine ablation is necessary and limits unnecessary bone marrow exposure for young patients in whom future leukaemia is of greater concern.

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Abbreviations

BMT:

Bone marrow transplantation

FNA:

Fine needle aspiration

Gy:

Gray

MEN2B:

Multiple endocrine neoplasia 2B

I123 :

Radioactive iodine 123

I131 :

Radioactive iodine 131

rTSH:

Recombinant thyroid stimulating hormone

TBI:

Total body irradiation

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Acknowledgments

We would like to acknowledge the help from Dr Greg Wheeler and Natalie Goroncy from Peter Maccallum Hospital, Melbourne in data collection. This study was not funded.

Authors’ contributions

First author did most of the data collection and analysis with help from the second author. Both had inputs in the writing of manuscript and its revision.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Wei Li Cindy Ho.

Ethics declarations

This article does not contain any studies with human participants or animals performed by any of the authors.

Conflict of interest

The authors.declare that they have no competing interests.

Additional information

Communicated by David Nadal

Revisions received: 21 October 2015; 17 December 2015

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Ho, W.L.C., Zacharin, M.R. Thyroid carcinoma in children, adolescents and adults, both spontaneous and after childhood radiation exposure. Eur J Pediatr 175, 677–683 (2016). https://doi.org/10.1007/s00431-016-2692-z

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  • DOI: https://doi.org/10.1007/s00431-016-2692-z

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