Pediatric differentiated thyroid carcinoma (DTC), which includes papillary (PTC) and follicular thyroid carcinoma (FTC), has an excellent prognosis (15-year survival rates >95%). The initial treatment in children generally consists of a (near) total thyroidectomy, followed by ablation therapy with radioiodine (131-I), nowadays, the latter often depends on risk stratification. TSH suppressive therapy with thyroid hormone has for decades been administered during follow-up to diminish the risk of recurrent disease. However, data about long-term effects of 131-I treatment, long-term TSH suppressive therapy and quality of life in pediatric DTC patients are limited. In the Netherlands a nationwide study in patients with pediatric DTC has been performed regarding presentation, treatment-related complications and outcome of treated and long term effects. Overall survival of 170 patients was 99.4% after a median follow-up of 13.5 (range 0.344.7) years. Medical follow-up data were available from 105 patients (83.8% women). At last follow-up, 8.6% patients had persistent disease and 7.6% patients had recurrent disease. Permanent hypoparathyroidism was found in 23.8%, 12.4% patients had recurrent laryngeal nerve injury. Health-related quality of life (RAND 36), fatigue (MFI20), anxiety and depression (HADS) scores of survivors and age, sex, and socioeconomic status survivors and matched controls did not differ significantly. However, survivors had more physical problems (P=0.031), role limitations due to physical problems (P=0.021), and mental fatigue (P=0.016) than controls. Evaluation of the achievement of psychosocial developmental milestones was evaluated by the course of life questionnaire (CoLQ) and showed similar development on social, autonomy, and psychosexual domains of survivors compared to controls. While systolic function is unaffected, diastolic dysfunction was present in 21.2% of the asymptomatic survivors, which may suggest early cardiac aging. In survivors clinically significant salivary gland dysfunction was found in 35.5%, related to the cumulative 131I activity.
Prof. dr. Thera P. Links, University of Groningen, University Medical Center Groningen, Department of Endocrinology, HPC AA31, P.O. Box 30.001, 9700 RB Groningen, the Netherlands. E-mail: firstname.lastname@example.org. Telephone nr: 003150 361 3962. Fax nr: 003150361 93 92
27 - 29 Sep 2018
European Society for Paediatric Endocrinology