Dear Dr Jamshid

as you mentioned the studied about this subject is limited and standard care about micro carcinoma in pediatric , but i suggest to study this paper:

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J Pediatr. 2015 Feb;166(2):451-6.e2. doi: 10.1016/j.jpeds.2014.10.023. Epub 2014 Nov 18.

Papillary thyroid carcinomas in patients under 21 years of age: clinical and histologic characteristics of tumors ≤10 mm.

Pazaitou-Panayiotou K1, Iliadou PK2, Mandanas S2, Vasileiadis T2, Mitsakis P2, Tziomalos K2, Alevizaki M3, Patakiouta F4.

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Abstract

OBJECTIVE:

To compare clinical and histologic characteristics of papillary thyroid carcinomas (PTCs) ≤10 mm in patients ≤21 years old with larger ones and with microcarcinomas in adults.

STUDY DESIGN:

Retrospective study of patients with PTC diagnosed between 1983 and 2012. Medical records were reviewed and information about age, sex, tumor size, intra/extrathyroid extension, lymph node, and distant metastases were collected.

RESULTS:

Patients ≤21 years old (n = 93) and adults (n = 1235) with PTC were identified. Among the former, 34 had PTC ≤10 mm (37.4%) and among the latter, 584 had papillary thyroid microcarcinoma (PTM) (47.3%), P = .082. Patients with tumors ≤10 mm less frequently had extrathyroidal extension and lymph node metastases compared with larger tumors (8.8% vs 33.3%, P = .017, and 60.0% vs 95.2%, P = .001, respectively). The percentage of PTC ≤10 mm increased with age (7.1%, 32.0%, and 48.1% in age groups ≤15, 15-18, and >18 to ≤21 years old, respectively; P = .016). Mean tumor size was larger (6.8 ± 2.7 vs 5.8 ± 2.8 mm, P = .030), and lymph nodes metastases were more frequent (41.2% vs 18.6%, P = .003) in patients ≤21 years of age compared with adults with PTM. The frequency of multifocal cancers decreased between 1983-1992, 1993-2002, and 2003-2012 (66.7%, 53.6%, and 27.1%, respectively, P = .019).

CONCLUSIONS:

The frequency of PTC ≤10 mm is low in children, increases in adolescents, and reaches that of adults at 18-21 years of age. Mean tumor size is larger and metastases to regional lymph nodes more frequent in comparison with PTM in adults. Whether their treatment and follow-up could be based on guidelines used for PTM in adults is questionable.

Best regards

Dear Jamshid,

Surely, due to small sizes of thyroid tumours, T-Staging will be of poor efficacy in revealing and determining stages of tumours. From this background why not apply biomarkers. On the other hand, as I know, not all of currently used oncological biomarkers are enough reliable in sense of revealing malignant tumour on initial stage but certain choice among them could be done.  In our studies, we found significant sensitivity of measuring the level of serotonin-modulation anticonsoldation protein (SMAP, Mekhtiev, 2000) in the platelets of patients with different localization of malignant tumours. Recently conducted structural analysis shwed that SMAP appeared to be DPYL2 protein engaged in initiation and progression of malignant tumours. Earlier we have shown its engagement in anti-mutagenic protection (Mekhtiev, Movsum-zade, 2008) and suppressive activity of growth Lewis carcinoma in pure-bred mice (Mekhtiev et al., 2016). 

With kind regards.

Dear Jamshid;

Thank you so much for putting forward this interesting question. You concern about underestimation of PTMC risk is quite real in children.

1- PTC microcarcinoma is rapidly increasing in the world mainly due to availability of high resolution ultrasonography and density of endocrinologists! Children is not away from this inadvertent screenings. Ito et al from Japan showed in prospective study of >1200 patients with PTMC that surgery should not be offered to >90% of these patients. Interestingly in that report, younger patients (