Francis Gary, Waguespack Steven G
a Division of Pediatric Endocrinology and Metabolism, Virginia Commonwealth University, 1001 E Marshall Street, Richmond, VA 23298, USA.
b Department of Endocrine Neoplasia and Hormonal Disorders, Department of Pediatrics, University of Texas MD Anderson Cancer Center, PO Box 301402, Unit 1461, Houston, TX 77230-1402, USA.
Expert Rev Endocrinol Metab. 2011 Jan;6(1):85-92. doi: 10.1586/eem.10.66.
Children with differentiated thyroid cancer (DTC) often present with extensive disease that inclined clinicians in prior decades toward aggressive treatment including total thyroidectomy, radical neck dissection and universal prescription of radioactive iodine (RAI). Recent series with 40 years of follow-up have shown that fewer than 2% of children ultimately die from DTC, but they may have increased all-cause mortality from second malignancies that might be related to previous radiation exposure. In this article, we review data to support the notion that an individualized, risk-stratified approach to therapy should be used for children with DTC. Ideally this will provide aggressive therapy for those in whom aggressive treatment is warranted, but withhold aggressive and risk-associated therapy from those who are not likely to benefit.
