According to a report, prepubertal children have more aggressive course of differentiated thyroid cancer (DTC) than in adolescents.

Primary care physicians should be aware that DTC, though very rare, may occur in pre-pubertal children, told co-author Dr. Moshe Phillip from Sackler Faculty of Medicine, Tel Aviv University, Israel. DTC in pre-pubertal patients has a more aggressive presentation with a more extensive spread of the tumor than in adolescents.

Dr. Phillip and team investigated whether there are any differences in the presentation, clinical course, and outcome of DTC between adolescents and prepubertal children.

The aurthors found that, at presentation, tumors tended to be more symptomatic in the prepubertal group than in the adolescent group. However, average tumor size and histological classification were comparable in the 2 groups.

At the time of diagnosis, prepubertal group commonly had multifocal sites of the tumor, extra-thyroid extension, positive nodal disease in the neck, and lung metastases than in the adolescent group.

The researchers reported that prepubertal children had short-term adverse effects of treatment, whereas longer term myelosuppression was documented only in pubertal patients.

The course and outcome in the 2 groups were comparable after a median follow-up of 5 years, including overall survival rates of 100% and normal linear growth in both groups.

Rigorous initial treatment (extensive surgery, relatively high radioiodine doses, and TSH suppression of <0.01 mIU/ml) by an experienced multidisciplinary team (pediatric endocrinologist, ENT surgeon, and nuclear medicine physician) resulted in extended recurrence-free survival in the pre-pubertal children, an outcome similar to that achieved in the pubertal group, Dr. Phillip said.