First guidelines for kids with thyroid nodules

For the first time, the American Thyroid Association (ATA) has issued guidelines specifically for evaluating and managing benign thyroid nodules and differentiated thyroid cancer (DTC) in children and adolescents aged 18 years and younger.

The guidelines, developed by the ATA Task Force on Pediatric Thyroid Cancer based on an extensive review of the medical literature, address the ways in which pediatric thyroid nodules and cancer differ biologically from adult thyroid cancers and provide targeted management recommendations. Thyroid nodules in children are uncommon but are more likely to be malignant than in adults, for example, and their pathophysiology, clinical presentation, and long-term outcomes are different.

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The task force recommends a wider range of treatment options for children and adolescents with DTC than for adults to reduce the use of aggressive therapy. “Therapy that may be recommended for an adult may not be appropriate for a child who is at low risk for death but at higher risk for long-term harm from over-aggressive treatment,” the task force writes.

Recent studies that followed survivors of childhood DTC over several decades show a rise in all-cause mortality primarily because of second cancers in children who were treated with radiation, the task force notes, adding that the “excellent prognosis” associated with childhood DTC is now better understood.

NEXT: What's covered in the guidelines?

The guidelines cover evaluation of thyroid nodules in children and adolescents, including ultrasound and fine-needle cytology, and management of the nodules, the most common manifestation of DTC. They also cover evaluation, treatment, and follow-up of DTC, including preoperative staging, surgery, postoperative staging, radioactive iodine treatment, and thyrotropin suppression.

The recommendations specifically address the papillary form of DTC. A separate section deals with treatment of the follicular form, which is rare in children and differs significantly from papillary thyroid cancer in clinical and biological characteristics.

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New cases of thyroid cancer in people aged younger than 20 years account for only about 1.8% of all thyroid cancers diagnosed in this country, but the incidence seems to be on the rise. Thyroid cancer is the eighth most often diagnosed malignancy in 15- through 19-year-olds and the second most common in girls, who are 5 times as likely as boys to be diagnosed with it. The incidence is 10 times greater in adolescents than in younger children.

The task force acknowledges that developing treatment guidelines was limited by a lack of randomized, double-blind, controlled clinical trials of DTC therapy in children and an average of only 10 years of follow-up in previous studies.