ATA Guidelines Tools

Differentiated Thyroid Cancer 16 Î Pulmonary function testing should be considered in all children with diffuse pulmonary metastases, especially if multiple 131 I treatments are planned. (C) Î Children with incidental PTC should be managed similarly to other children with ATA Pediatric Low-Risk disease. Neck US is recommended to detect contralateral disease or disease in the regional lymph nodes. Completion thyroidectomy is not required in those children who had less than a TT unless there is US evidence and cytologic confirmation of contralateral thyroid disease or malignant lymphadenopathy. (B) Î Most children with asymptomatic and non-progressive 131 I-refractory disease can be safely monitored while continuing TSH suppression. Systemic treatment for advanced thyroid cancer in children remains unstudied and at this time should be considered the purview of specialized centers for the treatment of children with thyroid cancer. Consultation with experts in this area should be invited prior to initiation of treatment. In exceptional cases where systemic treatment is contemplated, clinical trials are preferred. If unavailable, the use of oral kinase inhibitors may be considered. (C) Î Pediatric FTC is a rare malignancy. Because of the paucity of data regarding FTC in children, strong recommendations regarding therapy cannot be made and further studies are required to better understand the long-term outcomes and to risk-stratify children who would benefit from more extensive thyroid surgery and 131 I therapy. Î Patients with clear evidence of vascular invasion (>3 involved blood vessels), known distant metastasis, and/or tumor size >4 cm should be treated with total thyroidectomy and staged postoperatively with RAI. (C) Î Minimally-invasive FTC <4 cm in size and with no or minimal vascular invasion (≤3 involved blood vessels) should be treated on a case-by- case basis but lobectomy alone rather than total thyroidectomy with 131 I therapy may be sufficient. (C) Î In all children diagnosed with FTC, consideration should be given to genetic counseling and genetic testing for germline PTEN mutations particularly in the child with macrocephaly or with a family history suggestive of the PTEN hamartoma tumor syndrome. (C) Follicular Thyroid Carcinoma

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