First guidelines from the American Thyroid Association: Managing thyroid nodules, cancer in children
Previous guidelines from the American Thyroid Association (ATA) for evaluating and managing thyroid nodules and thyroid cancers targeted adults. Recognizing the potential differences in clinical presentation and long-term outcomes, and the potential risks of overly aggressive therapy in pediatric patients with thyroid cancer, an ATA Task Force developed management guidelines for children with thyroid nodules and differentiated thyroid cancer (DTC), which are published in Thyroid. The guidelines are available free on the Thyroid website.
The ATA Guidelines Task Force on Pediatric Thyroid Cancer, led by Chair Gary Francis, MD, PhD, Virginia Commonwealth University (Richmond), and Co-Chairs Steven Waguespack, MD, University of Texas MD Anderson Cancer Center (Houston), and Andrew Bauer, MD, Children's Hospital of Philadelphia, PA, based their recommendations on an extensive review of the medical literature related to clinical studies involving children and adolescents 18 years of age or younger. The evidence-based "Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer" cover a broad range of topics, including the use of ultrasound and fine-needle aspiration for cellular analysis to evaluate and manage benign thyroid nodules. Recommendations for assessing, treating, and monitoring children and adolescents with DTC cover all aspects of disease management, from pre-operative staging to surgical management, the role of radioactive iodine therapy, and the goals of thyrotropin suppression. Rather than a one-size-fits-all treatment strategy, the Task Force guidelines propose a broader scope of therapeutic options for pediatric patients with DTC with the aim of limiting the use of aggressive therapy when it is unlikely to offer benefit.
"These ATA guidelines fill an important gap and, for the first time, provide structured recommendations for the management of thyroid nodules and thyroid cancer in children. The guidelines specifically address the important differences in the biological behavior and management of these entities in children, and provide a much needed overview of the currently existing evidence," says Peter A. Kopp, MD, Editor-in-Chief of Thyroid and Associate Professor of Medicine, Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago.
"Unlike adults, thyroid nodules in children are more likely to be malignant, and the histopathology, molecular profile, and clinical behavior of differentiated thyroid cancer differs substantially," says Robert C. Smallridge, MD, President of the ATA, Professor of Medicine and former Chair, Endocrinology Division, Mayo Clinic, Jacksonville, Florida. "These first ATA guidelines highlight these distinguishing features for the clinician faced with caring for a patient with this uncommon thyroid tumor. The Task Force is to be commended for their comprehensive review and balanced recommendations."