儿童及青少年分化型甲状腺癌术后管理要点

Key points of postoperative management of children and adolescents with differentiated thyroid cancer

手术是治疗儿童及青少年分化型甲状腺癌(DTC的重要手段,而合理的术后管理是保障病人获得良好预后的关键环节。儿童及青少年DTC的术后管理方案应以病人为中心,以多维度的风险评估为基石,遵循个体化原则。术后内科治疗主要包括促甲状腺激素(TSH)抑制治疗和术后甲状旁腺功能减退的管理。儿童及青少年DTC病人术后需长期随访,并根据动态风险评估结果调整治疗和监测策略。术后内科治疗的副反应、病人罹患第二肿瘤的风险以及治疗的依从性等也应纳入长期随访监测的内容。对这一特殊群体的术后管理还需关注碘难治性DTC的诊治、病人的生长发育、心理健康和生活质量等方面。鉴于儿童及青少年DTC病人数量有限,未来应联合多中心力量,开展多学科合作,深入探讨个体化管理的决策指标和预测因素。

Though surgery is essential for the initial treatment of pediatric differentiated thyroid carcinoma(DTC),optimal postoperative management is a key component to ensure favorable outcomes in pediatric patients. Strategies for the postoperative management of children and adolescents with DTC should be patient-centered,individualized and on the basis of multidimensional risk assessment. Postoperative internal treatments mainly include TSH suppression and management of postoperative hypoparathyroidism. TSH suppression using levothyroxine has been an important cornerstone of postoperative treatment,especially for high-risk groups.Effective management of postoperative hypoparathyroidism can be achieved by administering calcium and vitamin D. Life-long follow-up and surveillance are necessary and recommended to all pediatric DTC patients. Medical strategies,intervals between follow-ups and approaches used for the surveillance should be adjusted according to dynamic risk assessments over time in the patients. Side effects of postoperative treatments,risk of second primary malignancy,as well as compliance with the treatment should also be monitored during the long-term follow-up of children and adolescents with DTC. Many aspects require more research to generate practical guides for managing postoperative pediatric patients. Examples include how to diagnose and treat advanced,radio-iodine refractory DTC;what are the effects due to postoperative management on growth and development,mental health,and quality of life. Given the limited number of pediatric DTC patients,in the future,multi-center and multi-disciplinary collaborations should be advocated and promoted. More studies are needed to explore the indicators and predictors that be of help for individualized decision-making on postoperative management.