World Journal of Surgery

, Volume 28, Issue 12, pp 1187–1198

Current Strategies for Surgical Management and Adjuvant Treatment of Childhood Papillary Thyroid Carcinoma

Authors

  • Geoffrey B. Thompson
    • Department of Surgery Mayo Clinic and Mayo Foundation
  • Ian D. Hay
    • Department of Surgery Mayo Clinic and Mayo Foundation
Article

DOI: 10.1007/s00268-004-7605-z

Cite this article as:
Thompson, G. & Hay, I. World J. Surg. (2004) 28: 1187. doi:10.1007/s00268-004-7605-z

Abstract

Childhood papillary thyroid carcinoma is associated with more locally aggressive and more frequent distant disease than its adult counterpart. Recurrence rates tend to be higher in children, but cause-specific mortality remains low. Optimal initial treatment of childhood papillary thyroid carcinoma should include total or near-total thyroidectomy and central compartment node clearance. Modified neck dissections should be performed for biopsy-proven lateral neck disease. Every effort should be made to maintain parathyroid and laryngeal nerve function. Radical neck dissections are to be avoided. Radioiodine remnant ablation (RRA), appropriate thyroid hormone suppressive therapy (THST), and judicious use of therapeutic doses of 131I are applied to achieve a disease-free status, which is most often confirmed by negative neck ultrasonography, negative whole-body scan (either withdrawal or recombinant human thyroid-stimulating hormone-stimulated), and extremely low levels of serum thyroglobulin. Appropriate utilization of 131I, THST, repeat surgery, external beam radiotherapy, and rarely chemotherapy may provide long-term palliation and some cures in patients with recurrent/persistent disease. Follow-up should be lifelong, and the care of children after age 17 should subsequently be transferred to adult-care endocrinologists with expertise in managing thyroid neoplasia. Optimal surgical management can be achieved if adequate operations are routinely carried out by “high-volume” thyroid surgeons with expertise in the care of children. Nowhere is a multidisciplinary approach (endocrinologists, surgeons, nuclear medicine physicians, pediatricians, pathologists, oncologists) more critical than in the long-term management of papillary thyroid carcinoma that presents during childhood.

Copyright information

© Société Internationale de Chirurgie 2004