Thyroid cancer is the most common secondary malignancy for survivors of childhood cancer, with radiation exposure before age 18 being the most significant risk factor. Current guidelines from the Children’s Oncology Group recommend yearly physical examination to palpate for thyroid nodules. Whilst other societies recommend periodic thyroid ultrasound, further evaluation with fine needle aspirate is typically not considered for nodules less than 10mm in diameter. We describe a case series of five patients with papillary thyroid carcinoma following radiation exposure, all with nodules <10mm (and some <5mm) and three with metastatic disease. There is debate in the literature regarding both necessity of routine surveillance and the optimal modality for screening, citing surveillance as potentially exposing patients to unnecessary harms and avoidable distress. Over the past 20 years, we have undertaken surveillance of 339 patients post-radiation exposure, utilising 2-yearly ultrasound, with an abnormality detected in 129/339 (38%). We will highlight the impalpable nature of smaller thyroid nodules, recommend utilisation of screening ultrasound and indicate a need to revise clinical guidelines for surveillance of paediatric and adolescent thyroid cancer post-radiation exposure.
15 Sep 2022 - 17 Sep 2022