Daniela Barros, post graduate student, Surgical Clinic Program, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto, SP, Brasil.
Pediatric thyroid cancer, though rare, has been increasingly recognized worldwide, driven by advances in detection and a growing understanding of its unique biological behavior. In this context, a 20-year retrospective study, Age-related characteristics in differentiated thyroid cancer: a 20-year single-center retrospective analysis in pediatric and adolescent patients (vol. 69, no. 2 , 2025), published by the journal Archives of Endocrinology and Metabolism, conducted by Dr. Laura Leite-Almeida and colleagues at the Unidade Local de Saúde São João and the Faculty of Medicine at the Universidade do Porto, Portugal, sought to shed light on how age at diagnosis impacts clinical features and outcomes in differentiated thyroid cancer (DTC) among children and adolescents.
The motivation for the study arose from the observation that the pediatric thyroid gland is particularly susceptible to carcinogenesis, especially following exposure to ionizing radiation, and that disease behavior may vary significantly with age. Despite these concerns, long-term outcome data for pediatric thyroid cancer remain scarce, and treatment guidelines are often extrapolated from adult populations. This underscores the importance of examining real-world data from pediatric cohorts to inform age-specific management strategies.
Image: voltamax via Pixabay
The primary objective was to characterize the clinical presentation, treatment, and outcomes of pediatric DTC patients over two decades, comparing those younger than 12 with their older counterparts. Age 12 was chosen as a cutoff given its typical alignment with puberty onset, despite the absence of precise pubertal data in retrospective cohorts.
The study involved 63 patients aged 0 to 18 years, with a mean age at diagnosis of 14.5 years and a female predominance (77%). Thirteen patients were younger than 12 years (mean 8.7 years), while 50 were 12 years or older (mean 16 years). Striking differences emerged between these groups:
- Palpable cervical lymph nodes were more common in younger children (45.4% vs. 10.4%);
- Solitary thyroid nodules predominated in older children (58.3% vs. 22.9%);
- Extrathyroidal extension was more frequent in younger patients (66.7% vs. 21.4%);
- Cervical lymph node metastasis occurred in 66.7% of younger children versus 24.4% of older ones;
- Surgical complications (recurrent laryngeal nerve injury, transient hypoparathyroidism) were more common in younger patients;
- Recurrence rates were significantly higher in younger children (15.4% vs. 2%);
- Two deaths were reported, both in patients with secondary thyroid neoplasia related to previous radiotherapy for other cancers.
The study also highlighted that older patients had a higher prevalence of previous neoplasia and radiation exposure, reflecting the complex interplay of prior oncologic treatments and thyroid cancer risk in survivors.
In discussing these findings, Dr. Leite-Almeida and colleagues emphasize that while the overall prognosis for pediatric thyroid cancer remains favorable, younger patients face unique challenges — including higher recurrence rates and more surgical complications.
These findings underscore the need for individualized, multidisciplinary care tailored to the specific risks and needs of younger patients. They also highlight the importance of incorporating pubertal staging into future research, as well as establishing international databases to refine and standardize treatment protocols globally.
The authors conclude that age-specific management strategies are essential to address the distinct clinical presentations and risks seen in younger pediatric patients. They advocate for heightened awareness among clinicians, robust collaborative studies, and careful long-term monitoring to ensure optimal outcomes for children and adolescents facing this rare but significant disease.
To read the article, access
LEITE-ALMEIDA, L., et al. Age-related characteristics in differentiated thyroid cancer: a 20-year single-center retrospective analysis in pediatric and adolescent patients. Archives of Endocrinology and Metabolism [online]. 2025, vol. 69, no. 2, e240333 [viewed 15 June 2025]. https://doi.org/10.20945/2359-4292-2024-0333. Available from: https://www.scielo.br/j/aem/a/Mnsw89BJWwjRDqRdpS4YqDc/
External links
Archives of Endocrinology and Metabolism – AEM
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