MacFarland SP, et al. - Researchers determined the influence as well as long-term outcome of concurrent Graves disease (GD) and differentiated thyroid cancer (DTC) (GD-DTC) in children and young adults. They found that, in pediatric patients with GD, the presence of concurrent DTC was not related to a greater disease burden and resulted in no significant difference in 2-year outcomes compared with DTC alone. They also reported the prevalence of microcarcinoma and tall cell variant papillary thyroid cancer in pediatric patients with GD-DTC is similar to what has been seen in adults. Definitive treatment should be guided by fine needle aspiration biopsy for patients with GD-DTC with an identified nodule on ultrasound imaging.

Methods

• This retrospective longitudinal cohort study was performed at a single institution between 1997 and 2016.
• Participants were 139 children and young adults with DTC, diagnosed at median age 15 (range, 5 to 23) years, compared to 12 patients with GD-DTC, median age 18 (range, 12 to 20) years.
• They assessed patient demographics, preoperative imaging, fine needle aspiration (FNA) cytology, operative and pathological reports, laboratory studies, treatment, and subsequent 2-year outcomes.

Results

• At the time of DTC diagnosis, patients with GD-DTC vs DTC were significantly older (P < 0.01).
• Findings revealed that microcarcinoma (P < 0.01) was more likely to be detected in patients with GD-DTC, and 2 of 12 (17%) showed tall cell variant papillary thyroid cancer (PTC) vs 2 of 139 (2%) patients who had DTC alone (P=0.03).
• They observed that patients with DTC exhibited greater lymphovascular invasion (60% vs 25%; P=0.03); extrathyroidal extension, regional lymph node, and distant or lung metastasis did not differ between the groups.
• They also found that 2-year outcome for remission, persistent disease, or recurrence did not differ between the groups.