Treatment of Recurrent Papillary and Follicular Thyroid Carcinoma

Despite having more advanced disease at presentation than adults, children with differentiated thyroid cancer generally have an excellent survival with relatively few side effects.[25,47,48] For this reason, treatment of persistent or recurrent disease should be individualized, and the potential risks and benefits of therapy should be carefully considered. For children with persistent but not rising thyroglobulin levels on TSH suppression, primary neck ultrasonography is recommended; if negative, 123I scanning may be considered under TSH stimulation. If no residual or recurrent disease is found, serum thyroglobulin and serum thyroglobulin antibodies must be measured every 3 to 6 months. Patients with small cervical foci (i.e., <1 cm) or patients with cervical disease that cannot be visualized with cross-sectional imaging may be considered for (repeat) therapeutic 131I. However, these patients may also be safely observed while maintaining TSH suppression. Macroscopic cervical disease should be removed surgically if it can be safely accomplished. Children with pulmonary metastases may continue to experience posttherapy targeted 131I effects for years, and an undetectable thyroglobulin level should not be the focus of treatment efforts. As many as one-third of patients exhibit persistent but stable disease following RAI. Therapy should be considered only in patients who show signs of progression.[9,24]

Treatment options for recurrent papillary and follicular thyroid carcinoma include the following: