Structural Disease Risk Stratification in Pediatric Patients With Thyroid Cancer

Light micrograph of thyroid cancer
Light micrograph of thyroid cancer
Revised ATA guidelines have led to an increased interest in risk-adopted management strategies for differentiated thyroid cancer.

A patient’s initial responses to therapy for thyroid cancer may allow clinicians to predict the risk for structural disease using dynamic risk stratification, according to a study published in Endocrine.

Researchers identified and retrospectively reviewed data from 130 patients (mean age: 16.2) with differentiated thyroid cancer (93.1% papillary thyroid cancer; 6.9% follicular thyroid cancer). Based on American Thyroid Association (ATA) guidelines, participants were placed into 3 initial risk groups (low, intermediate, and high) and 4 dynamic risk stratification groups (excellent, indeterminate, biochemical incomplete, or structural incomplete).


The highest rate of structural disease was identified in the structural incomplete group (100%). Structural disease was also identified in 3.9% of patients in the excellent group, 9.7% in the indeterminate group, and 76.9% in the biochemical incomplete group (hazard ratio [HR] 18.10 and 19.583 in the biochemical and structural incomplete groups, respectively; P <.001). The prevalence of structural disease increased with an increase in ATA risk classification (low-risk: 5.69%; intermediate-risk: 13.6%; high-risk: 45%; HR: 10.296 in the high-risk group; P <.001).

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The investigators concluded that “[Dynamic risk stratification] and the recently proposed ATA initial risk assessment for pediatric [differentiated thyroid cancer] can effectively predict structural persistence/recurrence in pediatric patients.” Based on these results, clinicians should apply the recommended risk stratification tools to predict clinical outcomes and improve disease surveillance in pediatric patients with thyroid cancer.


Sohn SY, Kim YN, Kim HI, Kim TH, Kim SW, Chung JH. Validation of dynamic risk stratification in pediatric differentiated thyroid cancer [published online August 18, 2017]. Endocrine. doi:10.1007/s12020-017-1381-7