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.