Endocrine Abstracts

Introduction: Differentiated thyroid carcinoma is the most common pediatric endocrine malignancy (0.5–3% of all childhood malignancies) with papillary thyroid carcinoma (PTC) being the most common type. Children have higher rates of cervical lymph node metastases, distant metastasis and recurrence. We report the case of a patient who presented a thyroid nodule whose exploration revealed PTC, to illustrate clinical, ultrasonographic and therapeutic features.

Clinical Case: Nine years-old patient, with no personal history, admitted for thyroid nodule whose evolution dated back 2 years with, on current ultrasound, a right lobar nodule, 28×17 mm (initially 17×17), oval, isoechoic, heterogeneous with multiple scattered micro-calcifications, mixed vascularization classified Eu-tirads 4 with jugulo-carotid and sub-mandibular nodes of sub-centimetric size. Clinically, no signs of dysthyroidism and was hemodynamically and respiratorily stable. Biological thyroidien tests was normal. A thyroid cytopunction revealed a follicular nodule with epithelial atypia of undetermined significance (category III). The child underwent right lobo-isthmectomy with extemporaneous sampling revealing papillary carcinoma, totalization performed with bilateral central lymph node curage In the post-operative period, the child began to experience clincal signs of hypocalcemia; peri-labial tingling, paresthesias, needles with a positive chvosteak sign in the presence of corrected calcemia at 78 mg/l. Intravenous calcium replacement was initiated, followed by oral replacement. Substitutive and inhibitory treatment has been initiated and will be adjusted according to the risk of recurrence. Patient scheduled for iratherapy 131-I* in one month.

Discussion: Children with PTC have shown a significantly higher local and regional recurrence over time when they undergone a loboisthmectomy compared to those who underwent total thyroidectomy. the high rate of multifocality (42–65%) reported in children with differentiated thyroid cancers have influenced others to recommend total thyroidectomy for all children with disease limited to the thyroid (1, 2). In view of the higher rate of cervical metastasis among children, ATA recommends prophylactic central compartment neck dissection (CCND) (1). Higher rates of post-thyroidectomy hypocalcemia among children when compared to adults is well recognized (3). CCND, extrathyroidal extension and the presence of nodal disease in the neck are the reported risk factors. Recurrence rate was significantly reduced when RAI therapy was performed.

Conclusion: PTC in children is characterized by the frequency of cervical and distant lymph node metastases and recurrences after treatment compared with adults, which justifies the use of total thyroid surgery with lymph node dissection followed by iratherapy, thus guaranteeing a better prognosis.

Keywords: PTC, chidren, metastases, total thyroidectomy, iratherapy.