No experience so far. We have 4 such patients in our centre. But all just underwent total thyroidectomy and then the paediatrics endocrinologist just follow them up. No RAI needed according to our paeds endocrinologist Prof Fatimah.

Radioactive therapy with iodine 131 (131 I) is indicated to ablate residual normal thyroid and to treat functioning metastases in differentiated thyroid tumors. Because pediatric patients are few and the prognosis is generally excellent, 131I is usually recommended only for patients with extensive unresectable cervical nodal involvement, invasion of vital structures, or distant metastases.

From Rivkees SA1, Mazzaferri EL, Verburg FA, Reiners C, Luster M, Breuer CK, Dinauer CA, Udelsman R.

The treatment of differentiated thyroid cancer in children: emphasis on surgical approach and radioactive iodine therapy. Endocr Rev. 2011 Dec;32(6):798-826. doi: 10.1210/er.2011-0011. Epub 2011 Aug 31.

Ample evidence suggests that more extensive surgery is associated with lower rates of recurrence. Surgery is associated with clear and definable rates of complications that can be minimized when surgery is performed by high-volume thyroid surgeons. Evidence shows that, when properly applied, RAI is associated with lower recurrence rates. Evidence also shows that DTC is associated with an increase SPM risk, which reflects intrinsic factors related to having DTC itself. Evidence also suggests that relatively high doses of 131I may contribute to an increased risk of SPM. Thus, the proven benefit of 131I in preventing cancer recurrence and cancer-related deaths needs to be weighed against potential long-term risks.

Based on the constellation of the above information, the following recommendations are made for children with DTC (Figs. 5 and and66).

Fig. 5.Algorithm for the evaluation and treatment of DTC in children. US, Ultra

Thanks Dr Lena. We have quite a number of patients in this age group. And, I do agree on giving radioiodine if tumour is >1.0cm. Because, in my experience, almost all patients demonstrated metastasis either lymph node or lungs on our first initial radioiodine whole body scan. They all received radioiodine treatment. Some responded but some were not that lucky. But, both of the two groups were well during follow up until adulthood. It seems likely that radioiodine improves survival outcome in these two groups. Anyway, these patients usually have very good prognosis and long survival whether metastases or not. So, it is very difficult to carry out such cohort.