The most recent recommendations from the ATA are that all of these indeterminate lesions be resected. And the reason that they have recommended that, which is different than the recommendations for adults, so the reason that children are recommended to have resection for their indeterminate lesions is their risk of malignancy is higher than adults.
The most recent recommendations from the ATA are that all of these indeterminate lesions be resected. And the reason that they have recommended that, which is different than the recommendations for adults, so the reason that children are recommended to have resection for their indeterminate lesions is their risk of malignancy is higher than adults.
The most recent recommendations from the ATA are that all of these indeterminate lesions be resected. And the reason that they have recommended that, which is different than the recommendations for adults, so the reason that children are recommended to have resection for their indeterminate lesions is their risk of malignancy is higher than adults.
The current recommendations for patients with papillary thyroid cancer because of the risk of bilateral disease, which is seen in up to 30% of patients, multifocal disease, which is seen in up to 65% of pediatric patients.
The current recommendations for patients with papillary thyroid cancer because of the risk of bilateral disease, which is seen in up to 30% of patients, multifocal disease, which is seen in up to 65% of pediatric patients.
The current recommendations for patients with papillary thyroid cancer because of the risk of bilateral disease, which is seen in up to 30% of patients, multifocal disease, which is seen in up to 65% of pediatric patients.
clinicalRisk factors for thyroid nodules and cancer include previous exposure to radiation or alkylating agents, such as treatment for Hodgkin's lymphoma, leukemia, or CNS tumors.↗
▶Ep 3 · 4:27
clinicalSome thyroid conditions and thyroid cancers have familial predisposition, including MEN syndromes, PTEN hamartoma tumor syndromes, and APC-associated polyposis syndromes.↗
▶Ep 3 · 6:23
quoteThyroid nodules are less common in children than adults, when they're detected, they're more likely to be malignant.↗
▶Ep 3 · 6:23
epidemiologicalThyroid nodules are less common in children than adults, but when detected in children, they are more likely to be malignant.↗
▶Ep 3 · 6:31
clinicalWhen children present with thyroid cancer, they are more likely to have extension outside of the thyroid, regional lymph node involvement, and distant metastasis compared to adults.↗
▶Ep 3 · 6:31
quoteWhen children actually do present with a thyroid cancer, they're more likely to have an extension outside of the thyroid. They're more likely to have regional lymph node involvement. And distant metastasis.↗
▶Ep 3 · 7:24
guidelineIf TSH is suppressed, a nuclear thyroid scan should be obtained to identify hyperfunctioning nodules, which do not need to be biopsied if they are going to be resected.↗
▶Ep 3 · 9:57
clinicalSuspicious ultrasound features for thyroid malignancy include hypoechoic mass, irregular margins, increased blood flow, microcalcifications, or association with abnormal lymph nodes.↗
▶Ep 3 · 11:21
guidelineIn pediatric patients, size cutoffs used in adults (1 cm) cannot be applied for biopsy decisions; ultrasound characteristics and clinical context determine whether FNA is warranted.↗
▶Ep 3 · 11:21
quoteFor the pediatric population, we can't use size cutoffs as they do in adults. And so we use ultrasound characteristics in the clinical context to decide whether or not something should be biopsied and warrant FNA.↗
▶Ep 3 · 15:00
quoteThe current recommendations for patients with papillary thyroid cancer because of the risk of bilateral disease, which is seen in up to 30% of patients, multifocal disease, which is seen in up to 65% of pediatric patients.↗
▶Ep 3 · 15:00
guidelineTotal or near-total thyroidectomy is recommended for papillary thyroid cancer due to risk of bilateral disease (up to 30%), multifocal disease (up to 65%), increased risk of recurrence with lobectomy alone, and ability to optimize for radioactive iodine and use thyroglobulin as a tumor marker.↗
▶Ep 3 · 17:07
opinionNerve monitoring is used routinely during thyroidectomy, and while it does not decrease the risk of nerve injury, it is helpful in identifying the recurrent laryngeal nerve, especially in patients with bulky cervical disease.↗
▶Ep 3 · 17:07
quoteI do routinely use a nerve monitor in my practice, knowing that it will not decrease my risk of nerve injury, but I do find it helpful in identifying the nerve, especially in patients with bulky cervical disease.↗
▶Ep 3 · 18:33
guidelineThere is no evidence to support prophylactic lateral neck dissection in thyroid cancer; lateral neck dissection is performed only when lateral nodes are pathologically positive.↗
▶Ep 3 · 19:37
clinicalAfter total thyroidectomy, PTH levels less than 10 to 15 in recovery indicate higher risk for hypocalcemia, prompting initiation of calcium replacement or calcitriol.↗
▶Ep 3 · 21:12
guidelineLow-risk papillary thyroid cancer patients (disease confined to thyroid, no nodal involvement, T1B N0) require only thyroglobulin surveillance with TSH suppression to 0.5-1, ultrasound at 6 months postoperatively, then annually for 5 years.↗
▶Ep 3 · 21:48
guidelineIntermediate-risk patients (extensive central neck disease or any lateral neck disease) and high-risk patients (extensive regional disease, local invasion, or distant metastases) may require radioactive iodine postoperatively.↗
▶Ep 3 · 23:05
epidemiologicalFollicular lesions represent about one-third of thyroid FNA results and are indeterminate specimens.↗
▶Ep 3 · 23:50
quoteThe most recent recommendations from the ATA are that all of these indeterminate lesions be resected. And the reason that they have recommended that, which is different than the recommendations for adults, so the reason that children are recommended to have resection for their indeterminate lesions is their risk of malignancy is higher than adults.↗
▶Ep 3 · 23:50
guidelineCurrent ATA recommendations are that all indeterminate (follicular) lesions in children be resected, typically with lobectomy and removal of the isthmus.↗
▶Ep 3 · 24:07
epidemiologicalFor follicular lesions of undetermined significance, the risk of malignancy in adults is 5-15%, but in pediatric literature it is approximately 28%.↗
▶Ep 3 · 24:18
epidemiologicalFor follicular neoplasms, the reported malignancy rate was 15-30%, but more recent data suggests it is between 50% and 60% in children.↗
▶Ep 3 · 25:04
clinicalFrozen section cannot distinguish follicular adenoma from follicular carcinoma, but can identify papillary components.↗
▶Ep 3 · 25:36
quoteA frozen section will not be able to tell you a follicular adenoma from a follicular carcinoma.↗
▶Ep 3 · 26:10
guidelineFor follicular carcinoma with significant vascular invasion or tumor greater than 4 cm, completion thyroidectomy is recommended; smaller tumors with minimal vascular invasion can be monitored.↗
▶Ep 3 · 27:01
epidemiologicalAbout 30% of patients who undergo lobectomy may develop hypothyroidism at some point, so thyroid function monitoring is important even after partial thyroidectomy.↗
▶Ep 3 · 27:01
quoteAbout 30% of patients at some point may develop hypothyroidism. So it's important for patients that even if they've undergone just a lobectomy, that their thyroid function is monitored.↗
▶Ep 3 · 27:31
guidelineTSH suppression goals vary by ATA pediatric risk level: low-risk patients have a TSH goal of 0.5-1, while high-risk patients have a TSH goal of less than 0.1.↗
▶Ep 3 · 28:49
clinicalFor benign thyroid nodules greater than 4 cm, the sensitivity and specificity of FNA is decreased, so it is important to follow these lesions with repeat ultrasound in 6-12 months and repeat biopsy if enlarging or developing suspicious features.↗
▶Ep 3 · 29:49
clinicalInadequate FNA specimens occur in roughly 1-3% of cases and should be repeated in 3-6 months to avoid picking up atypia from trauma of the initial FNA.↗
▶Ep 3 · 31:34
guidelineSporadic medullary thyroid cancer is unusual in children, so routine calcitonin monitoring is not recommended for every child with a thyroid nodule.↗
▶Ep 3 · 31:34
quoteSporadic medullary thyroid cancer is unusual in children, so the current recommendations are not to do routine calcitonin monitoring in every patient that presents with a thyroid nodule.↗
▶Ep 3 · 33:01
guidelineFor medullary thyroid cancer, if initial calcitonin level is greater than 500, imaging should be performed to exclude metastatic disease, including CT of neck and chest, MRI or CT of abdomen (looking at liver), and bone scan.↗
▶Ep 3 · 33:36
clinicalMEN 2A patients can develop medullary thyroid cancer, pheochromocytomas, and hyperparathyroidism.↗
▶Ep 3 · 33:47
clinicalMEN 2B patients can develop medullary thyroid cancer, pheochromocytomas, mucosal neuromas, and a Marfanoid habitus with elongated features and joint laxity.↗
▶Ep 3 · 34:11
guidelineMEN 2B patients with RET 918 mutation present with thyroid cancer very early, as young as 3 months of age, and require thyroidectomy before 1 year of age.↗
▶Ep 3 · 34:39
quoteThere are reported cases of having medullary thyroid cancer as young as 3 months in the MEN2B group.↗
▶Ep 3 · 36:03
guidelineMEN 2A high-risk patients (most commonly RET 634 mutation) should have total thyroidectomy before age 5, with surveillance starting at age 3 including calcitonin, CEA, and ultrasounds; if calcitonin or ultrasound abnormalities develop, thyroidectomy should be performed at that time.↗
▶Ep 3 · 36:27
guidelineIf calcitonin levels exceed 40 in MEN patients undergoing surveillance, central neck dissection is recommended at the time of thyroidectomy.↗
▶Ep 3 · 36:52
clinicalChildren under age 10 have increased risk of complications from thyroidectomy, including hypoparathyroidism and nerve injury, due to smaller anatomy and smaller parathyroid glands.↗
▶Ep 3 · 36:59
guidelineFor MEN 2A moderate-risk patients, total thyroidectomy is recommended when serum calcitonin becomes elevated or if parents do not want to proceed with frequent surveillance.↗
▶Ep 3 · 37:47
guidelineMEN 2A moderate-risk patients do not tend to develop pheochromocytomas until their twenties or above, so screening begins at age 16; MEN 2A high-risk patients begin pheochromocytoma screening at age 11.↗
▶Ep 3 · 39:03
guidelineFor prophylactic thyroidectomy in MEN patients, if performed before calcitonin levels exceed 40, central lymph node dissection is not necessary.↗
▶Ep 3 · 40:08
guidelineAfter thyroidectomy for medullary cancer, if calcitonin levels are undetectable or normal, surveillance includes physical exam and neck ultrasounds every 6 months for 1 year, then annually.↗
▶Ep 3 · 40:22
guidelineIf postoperative calcitonin levels are greater than 150, imaging should be performed to detect metastasis, including CT neck and chest, MRI or CT abdomen, bone scan, and MRI of pelvis and axial skeleton.↗
▶Ep 3 · 41:38
guidelineSystemic therapy for medullary thyroid cancer (tyrosine kinase inhibitors, external beam radiation) has significant side effects and is reserved for patients with progressive disease not treatable with surgery, not for all patients with elevated calcitonin.↗
▶Ep 3 · 42:29
opinionFor Graves' disease in young children, thyroidectomy is often preferred over radioactive iodine due to concerns about risks of secondary malignancies from radioactive iodine.↗
▶Ep 3 · 43:52
clinicalSome pediatric patients with papillary thyroid cancer present with diffuse infiltration of the thyroid rather than a discrete nodule, often with clinically suspicious lymph nodes, which is a characteristic more common in children.↗
clinicalRisk factors for thyroid nodules and cancer include previous exposure to radiation or alkylating agents, such as treatment for Hodgkin's lymphoma, leukemia, or CNS tumors.↗
▶Ep 11 · 4:27
clinicalSome thyroid conditions and thyroid cancers have familial predisposition, including MEN syndromes, PTEN hamartoma tumor syndromes, and APC-associated polyposis syndromes.↗
▶Ep 11 · 6:23
quoteThyroid nodules are less common in children than adults, when they're detected, they're more likely to be malignant.↗
▶Ep 11 · 6:23
epidemiologicalThyroid nodules are less common in children than adults, but when detected in children, they are more likely to be malignant.↗
▶Ep 11 · 6:31
quoteWhen children actually do present with a thyroid cancer, they're more likely to have an extension outside of the thyroid. They're more likely to have regional lymph node involvement. And distant metastasis.↗
▶Ep 11 · 6:31
clinicalWhen children present with thyroid cancer, they are more likely to have extension outside of the thyroid, regional lymph node involvement, and distant metastasis compared to adults.↗
▶Ep 11 · 7:24
guidelineIf TSH is suppressed, a nuclear thyroid scan should be obtained to identify hyperfunctioning nodules, which do not need to be biopsied if they are going to be resected.↗
▶Ep 11 · 9:57
clinicalSuspicious ultrasound features for thyroid malignancy include hypoechoic mass, irregular margins, increased blood flow, microcalcifications, or association with abnormal lymph nodes.↗
▶Ep 11 · 11:21
guidelineIn pediatric patients, size cutoffs used in adults (1 cm) cannot be applied for biopsy decisions; ultrasound characteristics and clinical context determine whether FNA is warranted.↗
▶Ep 11 · 11:21
quoteFor the pediatric population, we can't use size cutoffs as they do in adults. And so we use ultrasound characteristics in the clinical context to decide whether or not something should be biopsied and warrant FNA.↗
▶Ep 11 · 15:00
quoteThe current recommendations for patients with papillary thyroid cancer because of the risk of bilateral disease, which is seen in up to 30% of patients, multifocal disease, which is seen in up to 65% of pediatric patients.↗
▶Ep 11 · 15:00
guidelineTotal or near-total thyroidectomy is recommended for papillary thyroid cancer due to risk of bilateral disease (up to 30%), multifocal disease (up to 65%), increased risk of recurrence with lobectomy alone, and ability to optimize for radioactive iodine and use thyroglobulin as a tumor marker.↗
▶Ep 11 · 17:07
opinionNerve monitoring is used routinely during thyroidectomy, and while it does not decrease the risk of nerve injury, it is helpful in identifying the recurrent laryngeal nerve, especially in patients with bulky cervical disease.↗
▶Ep 11 · 17:07
quoteI do routinely use a nerve monitor in my practice, knowing that it will not decrease my risk of nerve injury, but I do find it helpful in identifying the nerve, especially in patients with bulky cervical disease.↗
▶Ep 11 · 18:33
guidelineThere is no evidence to support prophylactic lateral neck dissection in thyroid cancer; lateral neck dissection is performed only when lateral nodes are pathologically positive.↗
▶Ep 11 · 19:37
clinicalAfter total thyroidectomy, PTH levels less than 10 to 15 in recovery indicate higher risk for hypocalcemia, prompting initiation of calcium replacement or calcitriol.↗
▶Ep 11 · 21:12
guidelineLow-risk papillary thyroid cancer patients (disease confined to thyroid, no nodal involvement, T1B N0) require only thyroglobulin surveillance with TSH suppression to 0.5-1, ultrasound at 6 months postoperatively, then annually for 5 years.↗
▶Ep 11 · 21:48
guidelineIntermediate-risk patients (extensive central neck disease or any lateral neck disease) and high-risk patients (extensive regional disease, local invasion, or distant metastases) may require radioactive iodine postoperatively.↗
▶Ep 11 · 23:05
epidemiologicalFollicular lesions represent about one-third of thyroid FNA results and are indeterminate specimens.↗
▶Ep 11 · 23:50
quoteThe most recent recommendations from the ATA are that all of these indeterminate lesions be resected. And the reason that they have recommended that, which is different than the recommendations for adults, so the reason that children are recommended to have resection for their indeterminate lesions is their risk of malignancy is higher than adults.↗
▶Ep 11 · 23:50
guidelineCurrent ATA recommendations are that all indeterminate (follicular) lesions in children be resected, typically with lobectomy and removal of the isthmus.↗
▶Ep 11 · 24:07
epidemiologicalFor follicular lesions of undetermined significance, the risk of malignancy in adults is 5-15%, but in pediatric literature it is approximately 28%.↗
▶Ep 11 · 24:18
epidemiologicalFor follicular neoplasms, the reported malignancy rate was 15-30%, but more recent data suggests it is between 50% and 60% in children.↗
▶Ep 11 · 25:04
clinicalFrozen section cannot distinguish follicular adenoma from follicular carcinoma, but can identify papillary components.↗
▶Ep 11 · 25:36
quoteA frozen section will not be able to tell you a follicular adenoma from a follicular carcinoma.↗
▶Ep 11 · 26:10
guidelineFor follicular carcinoma with significant vascular invasion or tumor greater than 4 cm, completion thyroidectomy is recommended; smaller tumors with minimal vascular invasion can be monitored.↗
▶Ep 11 · 27:01
quoteAbout 30% of patients at some point may develop hypothyroidism. So it's important for patients that even if they've undergone just a lobectomy, that their thyroid function is monitored.↗
▶Ep 11 · 27:01
epidemiologicalAbout 30% of patients who undergo lobectomy may develop hypothyroidism at some point, so thyroid function monitoring is important even after partial thyroidectomy.↗
▶Ep 11 · 27:31
guidelineTSH suppression goals vary by ATA pediatric risk level: low-risk patients have a TSH goal of 0.5-1, while high-risk patients have a TSH goal of less than 0.1.↗
▶Ep 11 · 28:49
clinicalFor benign thyroid nodules greater than 4 cm, the sensitivity and specificity of FNA is decreased, so it is important to follow these lesions with repeat ultrasound in 6-12 months and repeat biopsy if enlarging or developing suspicious features.↗
▶Ep 11 · 29:49
clinicalInadequate FNA specimens occur in roughly 1-3% of cases and should be repeated in 3-6 months to avoid picking up atypia from trauma of the initial FNA.↗
▶Ep 11 · 31:34
quoteSporadic medullary thyroid cancer is unusual in children, so the current recommendations are not to do routine calcitonin monitoring in every patient that presents with a thyroid nodule.↗
▶Ep 11 · 31:34
guidelineSporadic medullary thyroid cancer is unusual in children, so routine calcitonin monitoring is not recommended for every child with a thyroid nodule.↗
▶Ep 11 · 33:01
guidelineFor medullary thyroid cancer, if initial calcitonin level is greater than 500, imaging should be performed to exclude metastatic disease, including CT of neck and chest, MRI or CT of abdomen (looking at liver), and bone scan.↗
▶Ep 11 · 33:36
clinicalMEN 2A patients can develop medullary thyroid cancer, pheochromocytomas, and hyperparathyroidism.↗
▶Ep 11 · 33:47
clinicalMEN 2B patients can develop medullary thyroid cancer, pheochromocytomas, mucosal neuromas, and a Marfanoid habitus with elongated features and joint laxity.↗
▶Ep 11 · 34:11
guidelineMEN 2B patients with RET 918 mutation present with thyroid cancer very early, as young as 3 months of age, and require thyroidectomy before 1 year of age.↗
▶Ep 11 · 34:39
quoteThere are reported cases of having medullary thyroid cancer as young as 3 months in the MEN2B group.↗
▶Ep 11 · 36:03
guidelineMEN 2A high-risk patients (most commonly RET 634 mutation) should have total thyroidectomy before age 5, with surveillance starting at age 3 including calcitonin, CEA, and ultrasounds; if calcitonin or ultrasound abnormalities develop, thyroidectomy should be performed at that time.↗
▶Ep 11 · 36:27
guidelineIf calcitonin levels exceed 40 in MEN patients undergoing surveillance, central neck dissection is recommended at the time of thyroidectomy.↗
▶Ep 11 · 36:52
clinicalChildren under age 10 have increased risk of complications from thyroidectomy, including hypoparathyroidism and nerve injury, due to smaller anatomy and smaller parathyroid glands.↗
▶Ep 11 · 36:59
guidelineFor MEN 2A moderate-risk patients, total thyroidectomy is recommended when serum calcitonin becomes elevated or if parents do not want to proceed with frequent surveillance.↗
▶Ep 11 · 37:47
guidelineMEN 2A moderate-risk patients do not tend to develop pheochromocytomas until their twenties or above, so screening begins at age 16; MEN 2A high-risk patients begin pheochromocytoma screening at age 11.↗
▶Ep 11 · 39:03
guidelineFor prophylactic thyroidectomy in MEN patients, if performed before calcitonin levels exceed 40, central lymph node dissection is not necessary.↗
▶Ep 11 · 40:08
guidelineAfter thyroidectomy for medullary cancer, if calcitonin levels are undetectable or normal, surveillance includes physical exam and neck ultrasounds every 6 months for 1 year, then annually.↗
▶Ep 11 · 40:22
guidelineIf postoperative calcitonin levels are greater than 150, imaging should be performed to detect metastasis, including CT neck and chest, MRI or CT abdomen, bone scan, and MRI of pelvis and axial skeleton.↗
▶Ep 11 · 41:38
guidelineSystemic therapy for medullary thyroid cancer (tyrosine kinase inhibitors, external beam radiation) has significant side effects and is reserved for patients with progressive disease not treatable with surgery, not for all patients with elevated calcitonin.↗
▶Ep 11 · 42:29
opinionFor Graves' disease in young children, thyroidectomy is often preferred over radioactive iodine due to concerns about risks of secondary malignancies from radioactive iodine.↗
▶Ep 11 · 43:52
clinicalSome pediatric patients with papillary thyroid cancer present with diffuse infiltration of the thyroid rather than a discrete nodule, often with clinically suspicious lymph nodes, which is a characteristic more common in children.↗
clinicalRisk factors for thyroid nodules and cancer include previous exposure to radiation or alkylating agents, such as treatment for Hodgkin's lymphoma, leukemia, or CNS tumors.↗
▶Ep 8 · 4:27
clinicalSome thyroid conditions and thyroid cancers have familial predisposition, including MEN syndromes, PTEN hamartoma tumor syndromes, and APC-associated polyposis syndromes.↗
▶Ep 8 · 6:23
epidemiologicalThyroid nodules are less common in children than adults, but when detected in children, they are more likely to be malignant.↗
▶Ep 8 · 6:23
quoteThyroid nodules are less common in children than adults, when they're detected, they're more likely to be malignant.↗
▶Ep 8 · 6:31
quoteWhen children actually do present with a thyroid cancer, they're more likely to have an extension outside of the thyroid. They're more likely to have regional lymph node involvement. And distant metastasis.↗
▶Ep 8 · 6:31
clinicalWhen children present with thyroid cancer, they are more likely to have extension outside of the thyroid, regional lymph node involvement, and distant metastasis compared to adults.↗
▶Ep 8 · 7:24
guidelineIf TSH is suppressed, a nuclear thyroid scan should be obtained to identify hyperfunctioning nodules, which do not need to be biopsied if they are going to be resected.↗
▶Ep 8 · 9:57
clinicalSuspicious ultrasound features for thyroid malignancy include hypoechoic mass, irregular margins, increased blood flow, microcalcifications, or association with abnormal lymph nodes.↗
▶Ep 8 · 11:21
guidelineIn pediatric patients, size cutoffs used in adults (1 cm) cannot be applied for biopsy decisions; ultrasound characteristics and clinical context determine whether FNA is warranted.↗
▶Ep 8 · 11:21
quoteFor the pediatric population, we can't use size cutoffs as they do in adults. And so we use ultrasound characteristics in the clinical context to decide whether or not something should be biopsied and warrant FNA.↗
▶Ep 8 · 15:00
guidelineTotal or near-total thyroidectomy is recommended for papillary thyroid cancer due to risk of bilateral disease (up to 30%), multifocal disease (up to 65%), increased risk of recurrence with lobectomy alone, and ability to optimize for radioactive iodine and use thyroglobulin as a tumor marker.↗
▶Ep 8 · 15:00
quoteThe current recommendations for patients with papillary thyroid cancer because of the risk of bilateral disease, which is seen in up to 30% of patients, multifocal disease, which is seen in up to 65% of pediatric patients.↗
▶Ep 8 · 17:07
quoteI do routinely use a nerve monitor in my practice, knowing that it will not decrease my risk of nerve injury, but I do find it helpful in identifying the nerve, especially in patients with bulky cervical disease.↗
▶Ep 8 · 17:07
opinionNerve monitoring is used routinely during thyroidectomy, and while it does not decrease the risk of nerve injury, it is helpful in identifying the recurrent laryngeal nerve, especially in patients with bulky cervical disease.↗
▶Ep 8 · 18:33
guidelineThere is no evidence to support prophylactic lateral neck dissection in thyroid cancer; lateral neck dissection is performed only when lateral nodes are pathologically positive.↗
▶Ep 8 · 19:37
clinicalAfter total thyroidectomy, PTH levels less than 10 to 15 in recovery indicate higher risk for hypocalcemia, prompting initiation of calcium replacement or calcitriol.↗
▶Ep 8 · 21:12
guidelineLow-risk papillary thyroid cancer patients (disease confined to thyroid, no nodal involvement, T1B N0) require only thyroglobulin surveillance with TSH suppression to 0.5-1, ultrasound at 6 months postoperatively, then annually for 5 years.↗
▶Ep 8 · 21:48
guidelineIntermediate-risk patients (extensive central neck disease or any lateral neck disease) and high-risk patients (extensive regional disease, local invasion, or distant metastases) may require radioactive iodine postoperatively.↗
▶Ep 8 · 23:05
epidemiologicalFollicular lesions represent about one-third of thyroid FNA results and are indeterminate specimens.↗
▶Ep 8 · 23:50
guidelineCurrent ATA recommendations are that all indeterminate (follicular) lesions in children be resected, typically with lobectomy and removal of the isthmus.↗
▶Ep 8 · 23:50
quoteThe most recent recommendations from the ATA are that all of these indeterminate lesions be resected. And the reason that they have recommended that, which is different than the recommendations for adults, so the reason that children are recommended to have resection for their indeterminate lesions is their risk of malignancy is higher than adults.↗
▶Ep 8 · 24:07
epidemiologicalFor follicular lesions of undetermined significance, the risk of malignancy in adults is 5-15%, but in pediatric literature it is approximately 28%.↗
▶Ep 8 · 24:18
epidemiologicalFor follicular neoplasms, the reported malignancy rate was 15-30%, but more recent data suggests it is between 50% and 60% in children.↗
▶Ep 8 · 25:04
clinicalFrozen section cannot distinguish follicular adenoma from follicular carcinoma, but can identify papillary components.↗
▶Ep 8 · 25:36
quoteA frozen section will not be able to tell you a follicular adenoma from a follicular carcinoma.↗
▶Ep 8 · 26:10
guidelineFor follicular carcinoma with significant vascular invasion or tumor greater than 4 cm, completion thyroidectomy is recommended; smaller tumors with minimal vascular invasion can be monitored.↗
▶Ep 8 · 27:01
quoteAbout 30% of patients at some point may develop hypothyroidism. So it's important for patients that even if they've undergone just a lobectomy, that their thyroid function is monitored.↗
▶Ep 8 · 27:01
epidemiologicalAbout 30% of patients who undergo lobectomy may develop hypothyroidism at some point, so thyroid function monitoring is important even after partial thyroidectomy.↗
▶Ep 8 · 27:31
guidelineTSH suppression goals vary by ATA pediatric risk level: low-risk patients have a TSH goal of 0.5-1, while high-risk patients have a TSH goal of less than 0.1.↗
▶Ep 8 · 28:49
clinicalFor benign thyroid nodules greater than 4 cm, the sensitivity and specificity of FNA is decreased, so it is important to follow these lesions with repeat ultrasound in 6-12 months and repeat biopsy if enlarging or developing suspicious features.↗
▶Ep 8 · 29:49
clinicalInadequate FNA specimens occur in roughly 1-3% of cases and should be repeated in 3-6 months to avoid picking up atypia from trauma of the initial FNA.↗
▶Ep 8 · 31:34
quoteSporadic medullary thyroid cancer is unusual in children, so the current recommendations are not to do routine calcitonin monitoring in every patient that presents with a thyroid nodule.↗
▶Ep 8 · 31:34
guidelineSporadic medullary thyroid cancer is unusual in children, so routine calcitonin monitoring is not recommended for every child with a thyroid nodule.↗
▶Ep 8 · 33:01
guidelineFor medullary thyroid cancer, if initial calcitonin level is greater than 500, imaging should be performed to exclude metastatic disease, including CT of neck and chest, MRI or CT of abdomen (looking at liver), and bone scan.↗
▶Ep 8 · 33:36
clinicalMEN 2A patients can develop medullary thyroid cancer, pheochromocytomas, and hyperparathyroidism.↗
▶Ep 8 · 33:47
clinicalMEN 2B patients can develop medullary thyroid cancer, pheochromocytomas, mucosal neuromas, and a Marfanoid habitus with elongated features and joint laxity.↗
▶Ep 8 · 34:11
guidelineMEN 2B patients with RET 918 mutation present with thyroid cancer very early, as young as 3 months of age, and require thyroidectomy before 1 year of age.↗
▶Ep 8 · 34:39
quoteThere are reported cases of having medullary thyroid cancer as young as 3 months in the MEN2B group.↗
▶Ep 8 · 36:03
guidelineMEN 2A high-risk patients (most commonly RET 634 mutation) should have total thyroidectomy before age 5, with surveillance starting at age 3 including calcitonin, CEA, and ultrasounds; if calcitonin or ultrasound abnormalities develop, thyroidectomy should be performed at that time.↗
▶Ep 8 · 36:27
guidelineIf calcitonin levels exceed 40 in MEN patients undergoing surveillance, central neck dissection is recommended at the time of thyroidectomy.↗
▶Ep 8 · 36:52
clinicalChildren under age 10 have increased risk of complications from thyroidectomy, including hypoparathyroidism and nerve injury, due to smaller anatomy and smaller parathyroid glands.↗
▶Ep 8 · 36:59
guidelineFor MEN 2A moderate-risk patients, total thyroidectomy is recommended when serum calcitonin becomes elevated or if parents do not want to proceed with frequent surveillance.↗
▶Ep 8 · 37:47
guidelineMEN 2A moderate-risk patients do not tend to develop pheochromocytomas until their twenties or above, so screening begins at age 16; MEN 2A high-risk patients begin pheochromocytoma screening at age 11.↗
▶Ep 8 · 39:03
guidelineFor prophylactic thyroidectomy in MEN patients, if performed before calcitonin levels exceed 40, central lymph node dissection is not necessary.↗
▶Ep 8 · 40:08
guidelineAfter thyroidectomy for medullary cancer, if calcitonin levels are undetectable or normal, surveillance includes physical exam and neck ultrasounds every 6 months for 1 year, then annually.↗
▶Ep 8 · 40:22
guidelineIf postoperative calcitonin levels are greater than 150, imaging should be performed to detect metastasis, including CT neck and chest, MRI or CT abdomen, bone scan, and MRI of pelvis and axial skeleton.↗
▶Ep 8 · 41:38
guidelineSystemic therapy for medullary thyroid cancer (tyrosine kinase inhibitors, external beam radiation) has significant side effects and is reserved for patients with progressive disease not treatable with surgery, not for all patients with elevated calcitonin.↗
▶Ep 8 · 42:29
opinionFor Graves' disease in young children, thyroidectomy is often preferred over radioactive iodine due to concerns about risks of secondary malignancies from radioactive iodine.↗
▶Ep 8 · 43:52
clinicalSome pediatric patients with papillary thyroid cancer present with diffuse infiltration of the thyroid rather than a discrete nodule, often with clinically suspicious lymph nodes, which is a characteristic more common in children.↗
