Skip to main content

Advertisement

SpringerLink
Log in

Risk of structural persistent disease in pediatric patients with low or intermediate risk differentiated thyroid cancer

  • Original Article
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

Purpose

In pediatric patients with differentiated thyroid cancer (DTC), the risk of recurrence is high and the indication for postoperative 131I administration is still debated. The aim of this study was to assess the outcome in low and intermediate risk pediatric DTC patients.

Methods

We retrospectively evaluated 45 pediatric patients with low or intermediate risk DTC, treated with surgery and 131I between 1992 and 2002 and with no detectable antithyroglobulin (Tg) antibodies. Follow-up was performed every 6–12 months with Tg blood level determination and imaging procedures.

Results

During follow-up (64 ± 53 months), 15 events occurred (33% cumulative event rate, with an annual event rate of 5% person years). Five of these patients were submitted to additional surgery and all these 15 patients underwent a second 131I treatment course. All patients were alive at the end of the follow-up. Structural persistent disease occurred more frequently in patients at intermediate risk (p < 0.01) and in those with Tg values after thyroid hormone withdrawal >10 ng/ml before 131I therapy (p < 0.01). At multivariate analysis, only a postoperative thyroid stimulating hormone-stimulated Tg level >10 ng/ml was an independent predictor of persistent disease.

Conclusions

In pediatric patients with DTC, postoperative high stimulated Tg values (>10 ng/ml) should be taken into account for deciding the extent of both initial treatment and follow-up.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. N.L. Shapiro, N. Bhattacharyya, Population-based outcomes for pediatric thyroid carcinoma. Laryngoscope 115, 337–340 (2005)

    Article  Google Scholar 

  2. S. Dermody, A. Walls, E.H. Jr Harley, Pediatric thyroid cancer: an update from the SEER database 2007-2012. Int. J. Pediatr. Otorhinolaryngol. 89, 121–126 (2016)

    Article  Google Scholar 

  3. I.D. Hay, T.R. Johnson, S. Kaggal, M.S. Reinalda, N.M. Iniguez-Ariza, C.S. Grant, S.T. Pittock, G.B. Thompson, Papillary thyroid carcinoma (PTC) in children and adults: comparison of initial presentation and long-term postoperative outcome in 4432 patients consecutively treated at the Mayo Clinic during eight decades (1936-2015). World J. Surg. 42, 329–342 (2018)

    Article  Google Scholar 

  4. F. Borson-Chazot, S. Causeret, J.C. Lifante, M. Augros, N. Berger, J.L. Peix, Predictive factors for recurrence from a series of 74 children and adolescents with differentiated thyroid cancer. World J. Surg. 28, 1088–1092 (2004)

    Article  Google Scholar 

  5. D. Handkiewicz-Junak, J. Wloch, J. Roskosz, J. Krajewska, A. Kropinska, L. Pomorski, A. Kukulska, A. Prokurat, Z. Wygoda, B. Jarzab, Total thyroidectomy and adjuvant radioiodine treatment independently decrease locoregional recurrence risk in childhood and adolescent differentiated thyroid cancer. J. Nucl. Med. 48, 879–888 (2007)

    Article  CAS  Google Scholar 

  6. M. Schlumberger, F. De Vathaire, J.P. Travagli, G. Vassal, J. Lemerle, C. Parmentier, M. Tubiana, Differentiated thyroid carcinoma in childhood: long term follow-up of 72 patients. J. Clin. Endocrinol. Metab. 65, 1088–1094 (1987)

    Article  CAS  Google Scholar 

  7. G.L. Francis, S.G. Waguespack, A.J. Bauer, P. Angelos, S. Benvenga, J.M. Cerutti, C.A. Dinauer, J. Hamilton, I.D. Hay, M. Luster, M.T. Parisi, M. Rachmiel, G.B. Thompson, S. Yamashita; American Thyroid Association Guidelines Task Force., Management guidelines for children with thyroid nodules and differentiated thyroid cancer. Thyroid 25, 716–759 (2015)

    Article  Google Scholar 

  8. B.R. Haugen, E.K. Alexander, K.C. Bible, G.M. Doherty, S.J. Mandel, Y.E. Nikiforov, F. Pacini, G.W. Randolph, A.M. Sawka, M. Schlumberger, K. Schuff, S.I. Sherman, J.A. Sosa, D.L. Steward, M. Tuttle, L. Wartofsky, The American Thyroid Association (ATA) Guidelines Taskforce on thyroid nodules and differentiated thyroid cancer. 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid 26, 1–133 (2016)

    Article  Google Scholar 

  9. G.W. Randolph, Q.Y. Duh, K.S. Heller, V.A. LiVolsi, S.J. Mandel, D.L. Steward, R.P. Tufano, R.M. Tuttle, The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. Thyroid 22, 1144–1152 (2012)

    Article  Google Scholar 

  10. R.M. Tuttle, H. Tala, J. Shah, R. Leboeuf, R. Ghossein, M. Gonen, M. Brokhin, G. Omry, J.A. Fagin, A. Shaha, Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American Thyroid Association staging system. Thyroid 20, 1341–1349 (2010)

    Article  CAS  Google Scholar 

  11. M. Klain, L. Pace L, E. Zampella, T. Mannarino, S. Limone, E. Mazziotti, G. De Simini, A. Cuocolo, Outcome of patients with differentiated thyroid cancer treated with 131-iodine on the basis of a detectable serum thyroglobulin level after initial treatment. Front. Endocrinol. 10, 146 (2019)

    Article  Google Scholar 

  12. M.D. Ruopp, N.J. Perkins, B.W. Whitcomb, E.F. Schisterman, Youden index and optimal cut-point estimated from observations affected by a lower limit of detection. Biom. J. 50, 419–430 (2008)

    Article  Google Scholar 

  13. R. Ciappuccini, N. Heutte, G. Trzepla, J.P. Rame, D. Vaur, N. Aide, S. Bardet, Postablation (131)I scintigraphy with neck and thorax SPECT-CT and stimulated serum thyroglobulin level predict the outcome of patients with differentiated thyroid cancer. Eur. J. Endocrinol. 164, 961–969 (2011)

    Article  CAS  Google Scholar 

  14. B. Jarzab, D. Handkiewicz Junak, J. Włoch, B. Kalemba, J. Roskosz, A. Kukulska, Z. Puch, Multivariate analysis of prognostic factors for differentiated thyroid carcinoma in children. Eur. J. Nucl. Med. 27, 833–841 (2000)

    Article  CAS  Google Scholar 

  15. A.J. Alessandri, K.J. Goddard, G.K. Blair, C.J. Fryer, K.R. Schultz, Age is the major determinant of recurrence in pediatric differentiated thyroid carcinoma. Med. Pediatr. Oncol. 35, 41–46 (2000)

    Article  CAS  Google Scholar 

  16. M. Schlumberger, S. Leboulleux, B. Catargi, D. Deandreis, S. Zerdoud, S. Bardet, D. Rusu, Y. Godbert, C. Buffet, C. Schvartz, P. Vera, O. Morel, D. Benisvy, C. Bournaud, M.E. Toubert, A. Kelly, E. Benhamou, I. Borget, ESTIMABL1: favorable outcome after ablation in low risk thyroid cancer patients. Lancet Diabetes Endocrinol. 6, 618–626 (2018)

    Article  Google Scholar 

  17. M. Toubeau, C. Touzery, P. Arveux, G. Chaplain, G. Vaillant, A. Berriolo, J.M. Riedinger, C. Boichot, A. Cochet, F. Brunotte, Predictive value for disease progression of serum thyroglobulin levels measured in the postoperative period and after (131)I ablation therapy in patients with differentiated thyroid cancer. J. Nucl. Med. 45, 988–994 (2004)

    CAS  PubMed  Google Scholar 

  18. T.Y. Kim, W.B. Kim, E.S. Kim, J.S. Ryu, J.S. Yeo, S.C. Kim, S.J. Hong, Y.K. Shong, Serum thyroglobulin levels at the time of 131I remnant ablation just after thyroidectomy are useful for early prediction of clinical recurrence in low-risk patients with differentiated thyroid carcinoma. J. Clin. Endocrinol. Metab. 90, 1440–1445 (2005)

    Article  CAS  Google Scholar 

  19. A. Matrone, C. Gambale, P. Piaggi, D. Viola, C. Giani, L. Agate, V. Bottici, F. Bianchi, G. Materazzi, P. Vitti, E. Molinaro, R. Elisei, Postoperative thyroglobulin and neck ultrasound in the risk restratification and decision to perform 131I ablation. J. Clin. Endocrinol. Metab. 102, 893–902 (2017)

    PubMed  Google Scholar 

  20. J.D. Brierley, M.K. Gospodarowicz, C. Wittekind. TNM Classification of Malignant Tumours (John Wiley & Sons, Hoboken, NJ, 2017)

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy

    Michele Klain, Emilia Zampella, Mariarosaria Manganelli, Valeria Gaudieri, Carmela Nappi, Adriana D’Antonio, Leandra Piscopo, Fabio Volpe, Martin Schlumberger & Alberto Cuocolo

  2. Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy

    Leonardo Pace

Authors
  1. Michele Klain
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emilia Zampella
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mariarosaria Manganelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Valeria Gaudieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carmela Nappi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Adriana D’Antonio
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Leandra Piscopo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Fabio Volpe
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Leonardo Pace
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Martin Schlumberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Alberto Cuocolo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alberto Cuocolo.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all patients.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Klain, M., Zampella, E., Manganelli, M. et al. Risk of structural persistent disease in pediatric patients with low or intermediate risk differentiated thyroid cancer. Endocrine 71, 378–384 (2021). https://doi.org/10.1007/s12020-020-02379-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-020-02379-1

Keywords

Search

Navigation