Bal C S, Padhy A K, Kumar A
Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India.
Nucl Med Commun. 2001 Aug;22(8):881-7. doi: 10.1097/00006231-200108000-00006.
Northern India is an identified sub-Himalayan iodine-deficient endemic zone. We retrospectively analysed the case files of children with differentiated thyroid carcinoma from this endemic zone and attempted to define the disease in terms of its presentation, clinical course and outcome of radioiodine therapy. Between 1967 and June 2000, 1135 patients with thyroid cancer were treated in our centre and 80 (7%) were less than 20 years of age. There were 45 females and 35 males. Histologically, 85% of patients had papillary carcinoma and the rest follicular carcinoma. Cervical lymph node involvement was seen in 66% of patients, and distant metastasis, mainly pulmonary, in 29%. In children less than 10 years of age, 75% of patients had distant metastasis at the time of presentation. The post-surgery 48 h radioiodine neck uptake was 12.2+/-9.6%. Ninety-six per cent of the residual thyroid, 90% of nodal metastases and 57% of pulmonary metastases were ablated. Although nine patients had nodal recurrence between surgery and radioiodine treatment, no recurrence was observed thereafter, and three disease-related deaths (all in children less than 10 years of age) were seen in the mean follow-up of 6 years. We conclude that, except for the relatively higher incidence of follicular thyroid cancer and the higher mortality in the less than 10 year age group, the course and outcome of differentiated thyroid carcinoma in children from iodine-deficient areas is no different from that in children in iodine-sufficient areas.
印度北部是一个公认的喜马拉雅山次区域碘缺乏流行区。我们回顾性分析了来自该流行区的分化型甲状腺癌患儿的病例档案，并试图从其临床表现、临床病程和放射性碘治疗结果方面对该疾病进行界定。1967年至2000年6月期间，我们中心共治疗了1135例甲状腺癌患者，其中80例（7%）年龄小于20岁。女性45例，男性35例。组织学检查显示，85%的患者为乳头状癌，其余为滤泡状癌。66%的患者有颈部淋巴结受累，29%有远处转移，主要为肺部转移。在10岁以下的儿童中，75%的患者在就诊时已有远处转移。术后48小时放射性碘颈部摄取率为12.2±9.6%。96%的残余甲状腺、90%的淋巴结转移灶和57%的肺部转移灶被消融。虽然有9例患者在手术和放射性碘治疗之间出现淋巴结复发，但此后未观察到复发，在平均6年的随访中出现了3例与疾病相关的死亡（均为10岁以下儿童）。我们得出结论，除了滤泡状甲状腺癌的发病率相对较高以及10岁以下年龄组死亡率较高外，碘缺乏地区儿童分化型甲状腺癌的病程和结果与碘充足地区儿童无异。
