Martínez Ibáñez V, Pérez Martínez A, Roset Sánchez L, Sánchez de Toledo J, Regas Bech de Careda J, Marqués Gubern A
Ciudad Sanitaria, Valle de Hebrón Hospital Materno-Infantil, Barcelona.
An Esp Pediatr. 1993 Mar;38(3):229-31.
Thyroid carcinoma in childhood is a rare, but nevertheless malignant disease, with a high incidence of nodal metastasis. Seven children, 6 boys and 1 girl, aged 4 to 9 years with thyroid carcinoma were treated at the Hospital Infantil Valle de Hebrón of Barcelona between 1965 and 1990. The diagnosis was established by cervical nodal biopsy in all cases except one. Papillary carcinoma was found in 4 cases, follicular type in 2 cases and one case of mixed carcinoma was diagnosed. Surgical treatment consisted in lobectomy on the affected side, followed by total thyroidectomy on the opposite side and bilateral resection of involved nodes one or more times. In two patients, treatment with sodium-iodine I131 showed active tissue in the thorax and wound. Both were treated effectively. All patients are alive without recurrences during a follow-up period of 1 to 23 years. Main complications were: temporary recurrence of the nerve injury in two patients and a controlled hypoparathyroidism in another two cases. In all cases, treatment with L-thyroxine was required. Thyroid carcinoma in children carries a considerably better prognosis than in adult patients. We must suspect thyroid carcinoma and indicate biopsy in all cases of cervical nodes resistant to antibiotic treatment. Early diagnosis, total thyroidectomy, radioiodine treatment and hormone administration permit radical cure even in the case of metastatic disease.
儿童甲状腺癌是一种罕见但恶性的疾病,淋巴结转移发生率高。1965年至1990年间,巴塞罗那赫布龙山谷儿童医院收治了7名患有甲状腺癌的儿童,年龄在4至9岁之间,其中6名男孩,1名女孩。除1例病例外,所有病例均通过颈部淋巴结活检确诊。发现乳头状癌4例,滤泡型2例,诊断为混合癌1例。手术治疗包括患侧叶切除术,随后对侧全甲状腺切除术以及一次或多次双侧受累淋巴结切除术。两名患者接受碘-131钠治疗后,胸部和伤口处显示有活性组织。两人均得到有效治疗。所有患者在1至23年的随访期内均存活且无复发。主要并发症包括:两名患者出现暂时性神经损伤复发,另外两名患者出现可控性甲状旁腺功能减退。所有病例均需要使用左甲状腺素进行治疗。儿童甲状腺癌的预后比成年患者好得多。对于所有对抗生素治疗无反应的颈部淋巴结病例,我们必须怀疑甲状腺癌并进行活检。即使在转移性疾病的情况下,早期诊断、全甲状腺切除术、放射性碘治疗和激素给药也可实现根治。