Endocrine Abstracts

Differentiated thyroid cancer (DTC) in children and adolescents is a rare disease, however its incidence is rising worldwide, rendering it the most common pediatric endocrine neoplasia, representing 3% of all pediatric malignancies. Total thyroidectomy is the treatment of choice in pediatric DTC aiming a more recurrence-free and disease-free survival. Based on the presence of local or distant metastases, ¹³¹I radioiodine treatment is quite often required post-surgery. The radioiodine ¹³¹I is shallowed in a single capsule and is quickly absorbed in the gastrointestinal tract to enter the bloodstream. It is then concentrated to the iodine avid residual thyroid and metastatic tissue to fully eliminate the disease and decrease the risk of recurrence. An 11-years’ old girl with intellectual disability and a palpable neck mass was referred to our hospital for further investigation. Thyroid ultrasound revealed a solid, hypoechoic nodule of 34 × 17 × 21 mm in size, in the right thyroid lobe with calcifications, accompanied by Infiltrated local lymph nodes. The ultrasound-guided fine needle aspiration (FNA) confirmed the presence of papillary thyroid cancer (PTC), BETHESDA VI. The patient underwent a total thyroidectomy with central and bilateral lymph node dissection and the pathology showed classic PTC with infiltration of 20 of the 54 excised lymph nodes. Therefore, higher-intensity treatment with¹³¹I radioiodine (RAI) was indicated. Due to the patient’s history of intellectual disability with behavioral difficulties and denial in swallowing, the success of iodine treatment with oral administration was doubted. A multi-disciplinary team (MDT) meeting, consisting of pediatric endocrinologists, nuclear radiologists, gastroenterologists, surgeons and anesthesiologists, concluded to gastroscopy-guided RAI administration as the most effective way for RAI treatment. The patient was sedated and the iodine capsule 45mCi ¹³¹I was inserted via endoscope by the gastroenterologist to the stomach. The procedure was completed without iodine diffusion in the local environment. No further complications were recorded, and the patient was discharged after 24 hours. 7 days-post treatment whole body scan showed the expected iodine accumulation in the thyroid bed. Herein we describe for the first time in children an alternative way of RAI administration with endoscopy in patients with intellectual disability treated for advanced DTC. In our case this method was carried out successfully with a favorable outcome.