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New Guidelines for Managing Thyroid Cancer in Children

Recommendations recognize risks of aggressive therapy in young patients

Previous guidelines from the American Thyroid Association (ATA) for evaluating and managing thyroid nodules and thyroid cancers focused on adults.

Recognizing the potential differences in clinical presentation and long-term outcomes, and the potential risks of overly aggressive therapy in pediatric patients with thyroid cancer, an ATA task force has developed management guidelines for children with thyroid nodules and differentiated thyroid cancer (DTC). The new recommendations were published in Thyroid.

The ATA Guidelines Task Force on Pediatric Thyroid Cancer based their recommendations on an extensive review of the medical literature related to clinical studies involving children and adolescents 18 years of age or younger. The evidence-based guidelines cover a broad range of topics, including the use of ultrasound and fine-needle aspiration for cellular analysis to evaluate and manage benign thyroid nodules. The recommendations for assessing, treating, and monitoring children and adolescents with DTC cover all aspects of disease management, from pre-operative staging to surgical management, the role of radioactive iodine therapy, and the goals of thyrotropin suppression.

Rather than a one-size-fits-all treatment strategy, the task force guidelines propose a broader range of therapeutic options for pediatric patients with DTC with the aim of limiting the use of aggressive therapy when it is unlikely to offer a benefit.

“These ATA guidelines fill an important gap and, for the first time, provide structured recommendations for the management of thyroid nodules and thyroid cancer in children. The guidelines specifically address the important differences in the biological behavior and management of these entities in children, and provide a much-needed overview of the currently existing evidence,” said Peter A. Kopp, MD, Editor-in-Chief of Thyroid and an associate professor at Northwestern University Feinberg School of Medicine in Chicago, Illinois.

“Unlike adults, thyroid nodules in children are more likely to be malignant, and the histopathology, molecular profile, and clinical behavior of differentiated thyroid cancer differ substantially,” said Robert C. Smallridge, MD, President of the ATA and a professor of medicine at the Mayo Clinic in Jacksonville, Florida. “These first ATA guidelines highlight these distinguishing features for the clinician faced with caring for a patient with this uncommon thyroid tumor. The task force is to be commended for their comprehensive review and balanced recommendations.”

Sources: EurekAlert; April 22, 2015; and ATA Guidelines; April 22, 2015.

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