Pediatric versus adult papillary thyroid carcinoma: different diseases requiring different surgical approaches

Differentiated thyroid carcinoma is rare in young age and represents 0.5% to 3.0% of childhood carcinomas: the incidence increases with age, and peak incidence is observed between 15 and 19 years of age [1]. Even at large referral centers, only few pediatric thyroid cancers are treated every year; it may take ≥30 years for a major center to collect a series of 100 children and adolescents with thyroid cancer [2]. Papillary thyroid cancer (PTC), the most common type of differentiated thyroid cancer, spreads predominantly via the lymphatics to the local draining lymph nodes: cervical lymph node involvement in 60% to 80% of cases and lung metastases at diagnosis in 20% of cases [3]. Since pediatric thyroid cancer is such a rare disease, treatment recommendations have been based on expert opinion and retrospective data collected from different practices over decades [4-6]. Given the paucity of evidence-based pediatric data, guidelines for adult thyroid cancer occasionally have been generalized to children, treating them “just like little adults.” Such extrapolations may not be warranted, in particular when it comes to postoperative morbidity after thyroidectomy [7]