From 1936 to 1990, 89 children and adolescents (72 girls and 17 boys) were treated for differentiated
thyroid carcinoma at the University of Michigan Medical Center; 58 of these patients were first reported in 1971. Thirty (34%) patients had previously received external irradiation to the head and neck, although only 1 (3%) patient of the last 33 patients seen had this history. Patients first presenting from 1971 to 1990 had less advanced disease than those seen earlier. Also, during this time period, the rate of initial palpable cervical
adenopathy fell from 63% to 36%, local infiltration of primary
cancer from 31% to 6%, and initial pulmonary
metastases from 19% to 6%. The incidence of cervical nodal
metastases has remained 88% for 54 years. Papillary or the follicular variant of
papillary carcinoma was found in 93% of all patients. Seventy-nine (89%) patients had total or completion total
thyroidectomy. Surgical management of
lymphatic metastases varied from regional excision of nodes to
radical neck dissection. The overall rate of permanent accidental
recurrent laryngeal nerve palsy and
hypoparathyroidism was 4.5%, although neither has occurred in a child or adolescent undergoing surgery at the center in the past 25 years. The most recent 33 patients had a low rate of local/regional persistence or recurrence. Cervical nodal persistence occurred in 21%; there were no thyroid recurrences. Eighty-two percent of patients received 131I. The long-term mortality rate was 2.2%. We continue to advocate total
thyroidectomy, cervical
lymph node dissection, and postoperative 131I
therapy as the most
conservative treatment regimen for children with differentiated
thyroid carcinoma.