Abstract
Objectives: Despite the frequent finding of advanced disease in children with well-differentiated thyroid cancer at presentation and the high recurrence rate, overall survival is favorable. This inconsistency has led to confusion concerning the extent of treatment.
Methods: Between 1954 and 2001, 1194 patients with well-differentiated thyroid cancer were treated in our center; 75 of them were children (<21 years). Their files were retrospectively reviewed and the disease course, management, and outcome were recorded.
Results: Sixty patients (80%) had positive neck metastases. All 60 had central compartment lymph nodes, 37 (48%) had positive lateral neck nodes, and 4 had distant metastases. Total thyroidectomy was performed in 67 patients and hemi-thyroidectomy in 8. Concomitant neck treatment was performed in 65 patients. Adjuvant radio-iodine treatment was administered to all patients who underwent total thyroidectomy. There were 3 local (4%) and 7 neck (9%) recurrences, similar to the total recurrence rate in our adult population (11%). The recurrence rate was significantly lower in patients who underwent total thyroidectomy (6%) compared to patients who underwent hemithyroidectomy (38%) (P < 0.01). Type of neck dissection did not affect recurrence or appearance of distant metastases. All deaths (n = 3) were due to distant metastases, whereas 30% of the adult patients died of local and neck disease.
Conclusions: Our results indicate that the treatment of choice for young patients with well-differentiated thyroid cancer is total thyroidectomy. Regional diseases at presentation or recurrence do not affect survival in those patients.