青少年甲状腺癌临床特点和治疗选择

Thyroid cancer in children and adolescents:clinical characteristics and treatment strategies

青少年分化型甲状腺癌发病率不高,但与成人相比具有一些鲜明的特征:通常表现为甲状腺结节,诊断时多出现颈部淋巴结或远处转移,预后较好,总体存活率高。青少年分化型甲状腺癌宜行甲状腺全切除或近全切除术。对临床上已触及转移颈部淋巴结或超声检查阳性病例,首次手术应同时做颈部中央区淋巴结清扫。对颈侧区淋巴结活检阳性者,则应行改良的颈淋巴结清扫术,经典的颈淋巴结清扫术应避免。131I放射碘治疗是青少年分化型甲状腺癌的主要辅助治疗手段,应用左旋甲状腺素抑制治疗是青少年甲状腺癌术后的标准方法,但促甲状腺激素(TSH)最佳水平留有争论。

Differentiated thyroid carcinoma （DTC） is rare in children and adolescents. It has differences with adult DTC. DTC in children and adolescents usually presents as a solitary nodule, frequently present with lymph-node involvement and metastases at diagnosis than adults. Despite the presence of more extensive disease, long-term follow-up data show the favorable prognosis and longer overall survival. Total or near-total thyroidectomy is currently the standard of practice for papillary and follicular carcinomas in children and adolescents. Central compartment node removal at the time of initial surgery should be undertaken if nodes are detected by palpation or uhrasonography. Modified radical neck dissections should be performed in children with biopsy-proven lateral neck disease, and radical neck dissections should be avoided. Radioactive iodine （RAI）ablation with 131I is a mainstay of adjunctive DTC therapy for children and adolescents. It is standard practice to treat DTC patients in children and adolescents with levothyroxine postoperatively. The optimal degree of TSH suppression is debated.