Cancer of the thyroid in youth

Abstract

Abstract This is a review of 68 patients 20 years of age and younger with well‐differentiated carcinoma of the thyroid seen at the University of North Carolina Memorial Hospital and University of Iowa Hospital since 1935. These patients are included in the Thyroid Carcinoma Registry that provides continuing follow‐up of all patients with carcinoma of the thyroid at these 2 hospitals. The historical, clinical, laboratory, and surgical pathological findings in these 68 patients, their treatment, and survival are reported. Comparisons are made with findings in the 486 patients 21 years of age or older with well‐differentiated carcinoma of the thyroid seen during the same time. The most striking finding of this clinical investigation is that only 1 of the 68 patients, followed up for as long as 30 years, has died as a result of the well‐differentiated thyroid carcinoma. There was a history of irradiation to the head or neck, 28% of patients younger than 15 years of age, 15% of those 15 to 20 years of age, and 6% of patients older than 21 years. The results of this study reaffirm the conclusion that the treatment of well‐differentiated carcinoma of the thyroid in young patients as in older patients is empirical. Our experience suggests that the surgical approach should be determined by the biologic aggressiveness of the disease. Lobectomy, including isthmusectomy, is performed for well‐circumscribed lesions less than 2 cm in diameter in the absence of lymph node metastases. Near total thyroidectomy is advised in the presence of unilateral disease and ipsilateral lymph node metastases. Total thyroidectomy is performed for multifocal disease, when required to remove gross neoplasm, with bilateral lymph node metastases, and with follicular carcinoma in the presence of metastatic disease. Thyroid hormone therapy is used prophylactically. Radioiodine is advised for inoperable, residual, or recurrent disease .