Thyroid carcinoma in childhood.

UNLABELLED: Thyroid cancer in childhood is a rare and slowly progressive but nevertheless malignant disease that has a high incidence of nodal metastasis. Six children aged 8 to 15 years with well-differentiated thyroid carcinomas were treated at the Children's University Hospital of Zurich between 1960 and 1979. Diagnostic, therapeutic and follow-up procedures are discussed. All 6 patients are alive and without recurrences 1 to 16 years after diagnosis. 1. SURGICAL TREATMENT: Because of the frequency of intrathyroidal metastases, we prefer lobectomy on the affected side with resection of the isthmus and subtotal strumectomy on the opposite side, with preservation of the parathyroids. Grossly involved groups of nodes are resected. 2. Radiation therapy: Surgery is followed by external irradiation to the neck and mediastinum in cases of extrathyroidal extension of the tumour. 3. After I-131 ablation of remnant thyroid tissue, which permits the diagnosis of distant functioning metastases, several courses of radioiodine are applied as long as any functioning metastatic tissue is recognized. 4. Replacement therapy and suppression of endogenous stimulation by TSH are achieved by optimal hormonal treatment during the first years with triiodothyronine and later, after I-131 treatment has been concluded, with 1-thyroxine. 5. Lifelong follow-up is necessary, as late recurrences are possible.