Radionuclide imaging and treatment of thyroid cancer in children

Radioactive iodine (RAI) was first proposed as a specific treatment for thyroid cancer by Seidlin et al. in 1946 (1). Since then, RAI has been incorporated into treatment protocols for adults and children with differentiated thyroid cancer (DTC; 2). Adjunctive RAI therapy improves diseasefree survival in young adults (including some adolescents) with disease similar in histology and extent to that commonly found in children (3). Until recently, however, studies specifically examining the benefits of RAI in children have been difficult to perform because the number of patients is small and the prognosis is favorable for almost all children, regardless of adjunctive therapy (4-15). The American Thyroid Association and American Association of Clinical Endocrinologists have published practice guidelines for the management of thyroid cancer in adults, but the treatment of thyroid cancer in children remains controversial (2,16). A number of questions are left unresolved regarding the use of RAI in children. (1) Which children are most likely to benefit from RAI therapy? (2) What is the optimal dose of RAI for children?