Wiersinga W M
Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, The Netherlands.
J Pediatr Endocrinol Metab. 2001;14 Suppl 5:1289-96; discussion 1297-8.
Thyroid cancer is rare below the age of 16 years, with an annual incidence of 0.02-0.3 cases per 100,000. Papillary and follicular thyroid cancer in childhood and adolescence is more advanced upon presentation than in adults, as evident from a higher frequency of extra-thyroidal spread. The recurrence rate is also higher. Nevertheless, the prognosis for survival in children and adolescents is better than in adults; why this is so remains unclear. An approximately 30-fold increase in the incidence of thyroid cancer has been observed in children exposed to the fallout of the Chernobyl accident, especially in the age group of <1 year at the time of the disaster. Medullary thyroid cancer in childhood and adolescence occurs mainly as part of the MEN2 syndrome. Early detection by DNA mutation analysis and treatment by prophylactic thyroidectomy results in a potential normal life expectancy. Consequences in adult life relate to long-term complications of thyroid surgery, 131I treatment and TSH-suppressive doses of L-T4.
甲状腺癌在16岁以下较为罕见，年发病率为每10万人0.02 - 0.3例。儿童和青少年时期的乳头状和滤泡状甲状腺癌在初诊时比成人更晚期，甲状腺外扩散频率更高就表明了这一点。复发率也更高。然而，儿童和青少年的生存预后比成人更好；原因尚不清楚。在接触切尔诺贝利事故辐射尘的儿童中，尤其是在灾难发生时年龄小于1岁的儿童中，甲状腺癌发病率增加了约30倍。儿童和青少年时期的髓样甲状腺癌主要作为MEN2综合征的一部分出现。通过DNA突变分析进行早期检测并通过预防性甲状腺切除术进行治疗可实现潜在的正常预期寿命。成年后的后果与甲状腺手术、131I治疗和TSH抑制剂量的左甲状腺素的长期并发症有关。
