Abstract
The new histologic approach to papillary thyroid Ca includes subtypes with poor Droonosis (those with solid areas, diffuse infiltration, tall and columnar cell types), and others with good prognosis (encapsulated and predominantly follicular types).
A total group of 15 patients (ages X±SD 11.4±4.5yr, females, 12, males, 3) with a follow up of 1 to 6 years, was re-evaluated. Two had diffuse Ca with massive involvement of the gland, lymph nodes and miliary lung infiltration. Both cases had very high serum levels of calcitonin, X:220 pmol/L (normal value < 29 pmol/L) without areas of medullary carcinoma. Twelve tumors were of the conventional type and one was encapsulated.
Post-operative follow up was performed with thyroglobulin (Tg) measurements every 3 months (normal value for athyreotic patients: < 6 ng/ml) and total body scans every 6 to 12 months. Patients with residual thyroid tissue had Tg values over 14 ng/ml. Patients without tumor showed Tg < 3 ng/ml. A new strategy of follow up was carried out in 7 patients by using Thallium-201 (T1-201), a radiotracer of low radiation energy, without discontinuing 1-thyroxine (T4) treatment. Results were compared with conventional scintigram, performed with 5-10mCi 1-131 after 30 days of discontinuing T4. Findinas coincided in all patients using either Tl-201 or I-131. In conclusion: Diffuse Ca were more aggressive so total thyroidectomies were Performed in them, as well as in conventional types. The encapsulated Ca were treated with subtotal resection. According to the results of Tg values and Tl-201 scintigrams, we propose to restrict I-131 scans to patients with abnormal Tg values and/or residual thyroid tissue on T1-201 scan. Thus, both the interruption of 1-T4 treatment and the I-131 high radiation may be avoided in patients in whom treatment with I-131 is not necessary.
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Iorcansky, S., Moguilevsky, J., Zantleifer, D. et al. PAPILLARY THYROID CARCINOMA (Ca) IN CHILDREN AND ADOLESCENTS: DIFFERENCES IN AGGRESIVENESS AND NEW STRATEGY OF FOLLOW UP. Pediatr Res 38, 625 (1995). https://doi.org/10.1203/00006450-199510000-00051
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DOI: https://doi.org/10.1203/00006450-199510000-00051