Extensive surgery improves recurrence-free survival for children and young patients with class I papillary thyroid carcinoma

Catherine A. Welch Dinauer, R. Michael Tuttle, Daniel K. Robie, Donald R. McClellan, Gary L. Francis

Research output: Contribution to journalArticlepeer-review

60 Scopus citations

Abstract

Background: Children with papillary thyroid cancer (PTC) rarely die of their disease, but are at high risk for recurrence, particularly with multifocal tumors (which occur in 42% of children with PTC). It is not clear if more extensive surgery, with an increased risk of complications, lessens the risk for recurrence. The authors hypothesized that patients with disease presumed to be confined to the thyroid gland (class I PTC) could have multifocal disease, involving the contralateral lobe, of which the surgeon is unaware. Treatment with less than subtotal thyroidectomy might be associated with a higher risk of recurrence. Methods: The charts of 37 patients with Class I PTC diagnosed at ≤21 years of age between 1953 and 1996 were reviewed. The incidence of surgical complications and the risk of recurrence based on the extent of initial surgery ([1] lobectomy with or without isthmusectomy, [2] subtotal, or [3] total thyroidectomy) and adjunctive therapy with thyroid hormone or radioactive iodine (RAI) were examined. Results: Eight patients had recurrent PTC. Patients treated with lobectomy with or without isthmusectomy were more likely to have recurrence than patients treated with subtotal or total thyroidectomy (Odds ratio, 8.7; 95% CI 1.4 to 54). Although the incidence of complications was statistically similar among the 3 surgical groups, 3 patients, all treated with more extensive surgery, had permanent hypoparathyroidism. There were too few patients to determine whether treatment with thyroid hormone or RAI offered additional benefit. Conclusions: In children with Class I PTC, more extensive surgery is associated with a lower risk of recurrence. This finding must be weighed against the risk of complications when determining the optimal treatment for individual patients.

Original languageEnglish (US)
Pages (from-to)1799-1804
Number of pages6
JournalJournal of pediatric surgery
Volume34
Issue number12
DOIs
StatePublished - Dec 1999
Externally publishedYes

Keywords

  • Thyroid carcinoma
  • Thyroidectomy

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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