Thompson Geoffrey B, Hay Ian D
Department of Surgery, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, MN 55905, USA.
World J Surg. 2004 Dec;28(12):1187-98. doi: 10.1007/s00268-004-7605-z. Epub 2004 Nov 4.
Childhood papillary thyroid carcinoma is associated with more locally aggressive and more frequent distant disease than its adult counterpart. Recurrence rates tend to be higher in children, but cause-specific mortality remains low. Optimal initial treatment of childhood papillary thyroid carcinoma should include total or near-total thyroidectomy and central compartment node clearance. Modified neck dissections should be performed for biopsy-proven lateral neck disease. Every effort should be made to maintain parathyroid and laryngeal nerve function. Radical neck dissections are to be avoided. Radioiodine remnant ablation (RRA), appropriate thyroid hormone suppressive therapy (THST), and judicious use of therapeutic doses of (131)I are applied to achieve a disease-free status, which is most often confirmed by negative neck ultrasonography, negative whole-body scan (either withdrawal or recombinant human thyroid-stimulating hormone-stimulated), and extremely low levels of serum thyroglobulin. Appropriate utilization of (131)I, THST, repeat surgery, external beam radiotherapy, and rarely chemotherapy may provide long-term palliation and some cures in patients with recurrent/persistent disease. Follow-up should be lifelong, and the care of children after age 17 should subsequently be transferred to adult-care endocrinologists with expertise in managing thyroid neoplasia. Optimal surgical management can be achieved if adequate operations are routinely carried out by "high-volume" thyroid surgeons with expertise in the care of children. Nowhere is a multidisciplinary approach (endocrinologists, surgeons, nuclear medicine physicians, pediatricians, pathologists, oncologists) more critical than in the long-term management of papillary thyroid carcinoma that presents during childhood.
儿童乳头状甲状腺癌比成人乳头状甲状腺癌具有更强的局部侵袭性和更频繁的远处转移。儿童的复发率往往更高，但特异性死亡率仍然较低。儿童乳头状甲状腺癌的最佳初始治疗应包括全甲状腺或近全甲状腺切除术以及中央区淋巴结清扫。对于经活检证实的侧颈部病变，应进行改良颈淋巴结清扫术。应尽一切努力维持甲状旁腺和喉返神经功能。应避免根治性颈淋巴结清扫术。应用放射性碘残留消融（RRA）、适当的甲状腺激素抑制治疗（THST）以及合理使用治疗剂量的（131）I以实现无病状态，这通常通过颈部超声检查阴性、全身扫描阴性（停药或重组人促甲状腺激素刺激后）以及极低水平的血清甲状腺球蛋白来确认。合理使用（131）I、THST、再次手术、外照射放疗以及很少使用的化疗可为复发/持续性疾病患者提供长期缓解并实现部分治愈。随访应终身进行，17岁以后儿童的护理应随后转交给具有甲状腺肿瘤管理专业知识的成人内分泌科医生。如果由具有儿童护理专业知识的“高年资”甲状腺外科医生常规进行充分的手术，就可以实现最佳的手术管理。在儿童期出现的乳头状甲状腺癌的长期管理中，多学科方法（内分泌科医生、外科医生、核医学医生、儿科医生、病理科医生、肿瘤科医生）比其他任何地方都更为关键。
