Disease Burden and Outcome in Pediatric and Young Adults with Concurrent Graves Disease and Differentiated Thyroid Carcinoma.

TitleDisease Burden and Outcome in Pediatric and Young Adults with Concurrent Graves Disease and Differentiated Thyroid Carcinoma.
Publication TypeJournal Article
Year of Publication2018
AuthorsMacFarland SP, Bauer AJ, N Adzick S, Surrey LF, Noyes J, Kazahaya K, Mostoufi-Moab S
JournalJ Clin Endocrinol Metab
Date Published2018 May 18
ISSN1945-7197
Abstract

Context: Adults with differentiated thyroid carcinoma (DTC) and Graves Disease (GD) demonstrate a greater reported disease burden and aggressive DTC behavior. To date, no studies have examined the impact and long-term outcome of concurrent GD and DTC (GD-DTC) in pediatric and young adults.

Design: Single institution, retrospective longitudinal cohort study between 1997-2016.

Participants: 139 pediatric and young adults with DTC, diagnosed at median age 15 (range 5-23) years compared to 12 GD-DTC patients, median age 18 (range 12-20) years.

Major Outcome Measures: Patient demographics, pre-operative imaging, fine needle aspiration (FNA) cytology, operative and pathological reports, laboratory studies, treatment, and subsequent 2-year outcomes.

Results: Compared to DTC, GD-DTC were significantly older at the time of DTC diagnosis (p<0.01). GD-DTC were more likely to exhibit micro-carcinoma (p<0.01) and 2/12 (17%) demonstrated tall-cell variant PTC vs 2/139 (2%) in DTC alone (p=0.03). While DTC patients showed greater lymphovascular invasion (60% vs 25%; p=0.03), no group differences were noted in extra-thyroidal extension, regional lymph node, distant or lung metastasis. There were no group differences in the 2-year outcome for remission, persistent disease, or recurrence.

Conclusions: Concurrent DTC in pediatric GD patients is not associated with a greater disease burden at presentation and shows no significant difference in 2-year outcomes compared to DTC alone. Similar to adults, micro-carcinoma and tall-cell variant PTC is prevalent in pediatric GD-DTC. For GD-DTC patients with an identified nodule on ultrasound imaging prior to definitive therapy, FNA biopsy is recommended to guide definitive treatment.

DOI10.1210/jc.2018-00026
Alternate JournalJ. Clin. Endocrinol. Metab.
PubMed ID29788090