Case report describes aggressive papillary thyroid carcinoma in a pediatric patient, highlighting high survival rates alongside lifelong treatment complications.
Introduction: The prevalence of benign thyroid nodules in pediatric age group is 0.5-2%, detected by either palpation or ultrasound. The risk of thyroid nodules being malignant is 2-3 fold higher in children as compared to the adults. But, in general the prevalence of thyroid cancer is less, i.e. 1 in 10 lakh (<10 years) and 1 in 75K (>10years). Here we present an interesting case of pediatric thyroid nodule. Case Report: An 8 and half year girl presented with complaints of swelling over neck noticed since 1 month associated with viral fever and URTI. On examination she was detected with a nodular swelling of the thyroid gland. An US neck done urgently showed the presence of TIRADS 5 nodule (predominantly hypoechoic solid lesion, with smooth margins, of size 13 × 7mm, wider than tall and with multiple punctate echogenic foci at the isthmus). The nodule was subjected to FNAC, suggesting Bethesda Cat IV. She underwent total thyroidectomy and histopathology confirmed papillary thyroid carcinoma with angiolymphatic invasion and extrathyroidal extension and tumor deposits in one of the central lymph nodes. On follow up her WBI scan was negative but she showed biochemically incomplete response. Currently she is maintained on replacement LT4 supplements with a target TSH of <0.1 mIU/L. Conclusion: Pediatric DTCs are rare, they have aggressive presentation and are associated with lifelong treatment related complications, but they have excellent prognosis with 10-year survival rate of >98%. The management of pediatric DTCs also varies as compared to adults and one should aim at maintaining the excellence in prognosis along with reducing treatment related complications.
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Inamadar et al. (2024) studied this question.