Department of Endocrine Neoplasia & Hormonal Disorders, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
J Natl Compr Canc Netw. 2010 Nov;8(11):1289-300. doi: 10.6004/jnccn.2010.0095.
Children with differentiated thyroid cancer (DTC) often present with metastatic disease and have a high risk for recurrence, but rarely die of the disease. This article reviews DTC in children and discusses current approaches to their initial care and follow-up. These recommendations take into account the greater risk for recurrence and lower disease-specific mortality in these patients. Total thyroidectomy and central compartment lymph node dissection are appropriate for most children, but should be performed by a high-volume thyroid surgeon. Radioactive iodine (RAI) should generally be prescribed for those at very high risk for recurrence or known to have microscopic residual disease, and those with iodine-avid distant metastases. RAI should be considered in other patients only after carefully weighing the relative risks and benefits and the aggressiveness of the clinical presentation, because RAI may be associated with an increased risk for second malignancies and an increase in overall morbidity and mortality. All patients should be treated with thyroid hormone suppression, and follow-up should be lifelong. However, the degree of thyroid hormone suppression and frequency of disease surveillance usually decrease over time as patients are determined to be disease-free.
儿童分化型甲状腺癌（DTC）常发生远处转移，复发风险高，但死于该病者罕见。本文回顾了儿童 DTC，并讨论了目前针对其初始治疗和随访的方法。这些建议考虑到了此类患者的复发风险更高和疾病特异性死亡率更低的情况。大多数儿童都适合行全甲状腺切除术和中央区淋巴结清扫术，但应由甲状腺外科医生完成。对于那些复发风险极高或已知有镜下残留疾病、以及有碘摄取远处转移的患者，一般建议应用放射性碘（RAI）。只有在仔细权衡相对风险和获益以及临床表现的侵袭性后，才应考虑对其他患者应用 RAI，因为 RAI 可能与第二恶性肿瘤风险增加以及总发病率和死亡率增加相关。所有患者均应接受甲状腺激素抑制治疗，且应终生随访。但是，随着患者被确定无疾病，甲状腺激素抑制的程度和疾病监测的频率通常会随时间降低。
