Accessible Requires Authentication Published by De Gruyter August 29, 2018

Treatment outcomes in pediatric differentiated thyroid carcinoma

Nisha Bhavani, Kingini Bhadran, Vasantha Nair, Usha V. Menon, Praveen V. Pavithran, Arun S. Menon, Nithya Abraham, Aswin Pankaj and Harish Kumar



Until the American Thyroid Association (ATA) guidelines on management of pediatric differentiated thyroid carcinoma (DTC) became available in 2015, all children with DTC were treated like adults. This study aims to investigate the outcome of pediatric DTC and factors predicting the response to therapy in pediatric DTC managed according to adult guidelines.


Clinical records of 41 children less than 18 years of age diagnosed with DTC followed from 2007 in a single center were reviewed. According to the new ATA classification for pediatric DTC, five had low-risk, 28 had intermediate-risk and eight had high-risk disease at presentation.


There was no mortality or recurrence in this cohort of pediatric DTC patients and the cure rate was 46% during a mean follow-up of 44 months when they were managed according to adult guidelines. Neither the new ATA risk classification nor any clinicopathological character was identified which could predict the response to therapy. The new ATA guidelines would have avoided 27% of the radioiodine therapies given.


This study showed that DTC in children managed according to adult guidelines had a good cure rate. The new ATA guidelines on pediatric DTC might have drastically reduced the number of radioiodine therapies in the affected children. Long term prospective studies are needed to validate the benefits and risks of both these approaches.

Corresponding author: Dr. Nisha Bhavani, Professor, Professor, Department of Endocrinology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ernakulam 682041, Kerala, India, Phone: +91 9895972765, E-mail:


The authors thank members of the Amrita Thyroid Cancer Clinic and Department of Biostatistics, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ernakulam, Kerala, India, for supporting this work.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


1. Vergamini LB, Frazier AL, Abrantes FL, Ribeiro KB, Rodriguez-Galindo C. Increase in the incidence of differentiated thyroid carcinoma in children, adolescents, and young adults: a population-based study. J Pediatr 2014;164:1481–5. Search in Google Scholar

2. Pole JD, Zuk AM, Wasserman JD. Diagnostic and treatment patterns among children, adolescents, and young adults with thyroid cancer in Ontario: 1992–2010. Thyroid 2017;27:1025–33. Search in Google Scholar

3. Pellegriti G, Frasca F, Regalbuto C, Squatrito S, Vigneri R. Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemol 2013;2013:965212. Search in Google Scholar

4. International Agency for Research on Cancer 2004 World Health Organization classification of tumours. Pathology and genetics tumours of the endocrine organs. Available at: Search in Google Scholar

5. Halac I, Zimmerman D. Thyroid nodules and cancers in children. Endocrinol Metab Clin North Am 2005;34:725–44. Search in Google Scholar

6. Hay ID, Johnson TR, Kaggal S, Reinalda MS, Iniguez-Ariza NM, et al. 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 2017:1–14. Available from, DOI: 10.1007/s00268-017-4279-x. Search in Google Scholar

7. Alzahrani AS, Alkhafaji D, Tuli M, Al-Hindi H, Sadiq BB. Comparison of differentiated thyroid cancer in children and adolescents (£20 years) with young adults. Clin Endocrinol 2016;84:571–7. Search in Google Scholar

8. Chow SM, Law SC, Mendenhall WM, Au SK, Yau S, et al. Differentiated thyroid carcinoma in childhood and adolescence clinical course and role of radioiodine. Pediatr Blood Cancer 2004;42:176–83. Search in Google Scholar

9. Jarzab B, Handkiewicz-Junak D, Wloch J. Juvenile differentiated thyroid carcinoma and the role of radioiodine in its treatment: a qualitative review. Endocr Relat Cancer 2005;12:773–803. Search in Google Scholar

10. Sawka AM, Thabane L, Parlea L, Ibrahim-Zada I, Tsang RW, et al. Second primary malignancy risk after radioactive iodine treatment for thyroid cancer: a systematic review and meta-analysis. Thyroid 2009;19:451–7. Search in Google Scholar

11. Souza MC, Momesso DP, Vaisman F, Vieira Neto L, Martins RA, et al. Is radioactive iodine-131 treatment related to the occurrence of non-synchronous second primary malignancy in patients with differentiated thyroid cancer? Arch Endocrinol Metab 2016;60:9–15. Search in Google Scholar

12. Marti JL, Jain KS, Morris LG. Increased risk of second primary malignancy in pediatric and young adult patients treated with radioactive iodine for differentiated thyroid cancer. Thyroid 2015;25:681–7. Search in Google Scholar

13. Waguespack SG, Francis G. Initial management and follow-up of differentiated thyroid cancer in children. J Natl Compr Canc Netw 2010;8:1289–300. Search in Google Scholar

14. Francis GL, Waguespack SG, Bauer AJ, Angelos P, Benvenga S, et al. Management guidelines for children with thyroid nodules and differentiated thyroid cancer. Thyroid 2015;25:716–59. Search in Google Scholar

15. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, et al. Revised American Thyroid Association Management guidelines for patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2009;19:1167–214. Search in Google Scholar

16. AJCC Cancer Staging Manual, 7th edition. American Joint Committee on Cancer. Available at: Search in Google Scholar

17. Sung TY, Jeon MJ, Lee YH, Lee YM, Kwon H, et al. Initial and dynamic risk stratification of pediatric patients with differentiated thyroid cancer. J Clin Endocrinol Metab 2017;102:793–800. Search in Google Scholar

18. Hay ID, Gonzalez-Losada T, Reinalda MS, Honetschlager JA, Richards ML, et al. Long-term outcome in 215 children and adolescents with papillary thyroid cancer treated during 1940 through 2008. World J Surg 2010;34:1192–202. Search in Google Scholar

19. Hogan AR, Zhuge Y, Perez EA, Koniaris LG, Lew JI, et al. Pediatric thyroid carcinoma: incidence and outcomes in 1753 patients. J Surg Res 2009;156:167–72. Search in Google Scholar

20. Demidchik YE, Demidchik EP, Reiners C, Biko J, Mine M, et al. Comprehensive clinical assessment of 740 cases of surgically treated thyroid cancer in children of Belarus. Ann Surg 2006;243:525–32. Search in Google Scholar

21. Enomoto Y, Enomoto K, Uchino S, Shibuya H, Watanabe S, et al. Clinical features, treatment and longterm outcome of papillary thyroid cancer in children and adolescents without radiation exposure. World J Surg 2012;36:1241–6. Search in Google Scholar

22. Collini P, Massimino M, Leite SF, Mattavelli F, Seregni E, et al. Papillary thyroid carcinoma of childhood and adolescence: a 30-year experience at the Istituto Nazionale Tumori in Milan. Pediatr Blood Cancer 2006;46:300–6. Search in Google Scholar

23. Park S, Jeong JS, Ryu HR, Lee CR, Park JH, et al. Differentiated thyroid carcinoma of children and adolescents: 27-year experience in the Yonsei University Health System. J Korean Med Sci 2013;28:693–9. Search in Google Scholar

24. O’Gorman CS, Hamilton J, Rachmiel M, Gupta A, Ngan BY, et al. Thyroid cancer in childhood: a retrospective review of childhood course. Thyroid 2010;20:375–80. Search in Google Scholar

25. Balachandar S, La Quaglia M, Tuttle RM, Heller G, Ghossein RA, et al. A pediatric differentiated thyroid carcinoma of follicular cell origin: prognostic significance of histologic subtypes. Thyroid 2016;26:219–26. Search in Google Scholar

26. Qu N, Zhang L, Lu Z, Ji QH, Yang SW, et al. Predictive factors for recurrence of differentiated thyroid cancer in patients under 21 years of age and a meta-analysis of the current literature. Tumor Biol 2016;37:7797. Search in Google Scholar

27. Golpanian S, Perez EA, Tashiro J, Lew JI, Sola JE, et al. Pediatric papillary thyroid carcinoma: outcomes and survival predictors in 2504 surgical patients. Pediatr Surg Int 2016;32:201–8. Search in Google Scholar

28. Alessandri AJ, Goddard KJ, Blair GK, Fryer CJ, Schultz KR. Age is the major determinant of recurrence in pediatric differentiated thyroid carcinoma. Med Pediatr Oncol 2000;35:41–6. Search in Google Scholar

29. Pires BP, Alves Jr PA, Bordallo MA, Bulzico DA, Lopes FP, et al. Prognostic factors for early and long-term remission in pediatric differentiated thyroid carcinoma: the role of sex, age, clinical presentation, and the newly proposed American Thyroid Association risk stratification system. Thyroid 2016;26:1480–7. Search in Google Scholar

30. Mihailovic J, Nikoletic K, Srbovan D. Recurrent disease in juvenile differentiated thyroid carcinoma: prognostic factors, treatments, and outcomes. J Nucl Med 2014;55:710–7. Search in Google Scholar

31. Palmer BA, Zarroug AE, Poley RN, Kollars JP, Moir CR. Papillary thyroid carcinoma in children: risk factors and complications of disease recurrence. J Pediatr Surg 2005;40:1284–8. Search in Google Scholar

32. Vaisman F, Bulzico DA, Pessoa CH, Bordallo MA, Mendonca UB, et al. Prognostic factors of a good response to initial therapy in children and adolescents with differentiated thyroid cancer. Clinics 2011;66:281–6. Search in Google Scholar

33. Sohn SY, Kim YN, Kim HI, Kim TH, Kim SW, et al. Validation of dynamic risk stratification in pediatric differentiated thyroid cancer. Endocrine 2017;58:167. Search in Google Scholar

34. Brink JS, van Heerden JA, Mc Iver B, Salomao DR, Farley DR, et al. Papillary thyroid cancer with pulmonary metastases in children: long term prognosis. Surgery 2000;128:881–7. Search in Google Scholar

35. Biko J, Reiners C, Kreissl MC, Verburg FA, Demidchik Y, et al. Favourable course of disease after incomplete remission on (131)I therapy in children with pulmonary metastases of papillary thyroid carcinoma: 10 years follow-up. Eur J Nucl Med Mol Imaging 2011;38:651–5. Search in Google Scholar

Received: 2018-02-13
Accepted: 2018-07-13
Published Online: 2018-08-29
Published in Print: 2018-10-25

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