Study: Survival Is 'Excellent' in Pediatric Differentiated Thyroid Cancer

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Overall survival was 99.4% for patients who underwent thyroidectomy.
Overall survival was 99.4% for patients who underwent thyroidectomy.

Overall survival was high for Dutch patients who underwent total thyroidectomy for pediatric papillary or follicular thyroid carcinoma, although postoperative complications were common, according to results from a nationwide retrospective cohort study.

Researchers reviewed data on patients diagnosed and treated from 1970 to 2013. Median age at diagnosis was 15.6 years and most patients, 81%, were diagnosed with papillary thyroid carcinoma.

Of 169 survivors, 105 participated in this study. At a median follow-up of 13.5 years (range: 0.3 to 44.7 years), overall survival was 99.4%. Recurrence-free survival from initial treatment to first recurrence ranged from 3.9 to 22.7 years.

At last known follow-up, 9 patients (8.6%) had persistent disease, 6 of whom were classified as such based on a detectable thyroglobulin level. Eight patients (7.6%) experienced a recurrence and 3 of those patients relapsed within 5 years of initial treatment. Two of the 11 patients in the study who did not undergo ablation therapy with radioactive iodine within 6 months of total thyroidectomy experienced a recurrence (P=.197).

Sixteen patients (15.2%) had postoperative transient hypoparathyroidism and 25 (23.8%) had permanent hypoparathyroidism. Both transient and permanent hypoparathyroidism occurred more often in patients who underwent a lymph node dissection.

At initial diagnosis, 46 patients (43.8%) had histologically confirmed cervical lymph node metastases and 14 (13.3%) had distant metastases. Of those patients, 11 had lung metastases; 1 patient with follicular thyroid carcinoma had a metastasis in the seventh thoracic vertebra. Two patients with papillary thyroid carcinoma and 2 with follicular thyroid carcinoma had both lung and bone metastases.

Sixty-five patients (61.9%) underwent total thyroidectomy as a single procedure. The remaining patients underwent diagnostic hemithyroidectomy followed by a completion thyroidectomy.

Nearly all patients (99.0%) underwent thyroid-stimulating hormone (TSH) suppressive therapy. Researchers found that TSH level was not associated with recurrent disease, either in a crude model (odds ratio [OR]=1.98; 95% CI, 0.8- 4.86) or after adjustment for risk classification (OR=2; 95% CI, 0.78- 5.17).

“Survival of pediatric [differentiated thyroid cancer] is excellent. Therefore, minimizing treatment-related morbidity takes major priority,” the researchers wrote.

They noted more long-term studies and international collaboration are necessary to confirm their findings and improve care in this patient population.

Reference

  1. Klein Hesselink MS, Nies M, Bocca G, et al. Pediatric differentiated thyroid carcinoma in the Netherlands: a nationwide follow-up study. J Clin Endocrinol Metab. 2016. doi:10.1210/jc.2015-3290.
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