2015美国甲状腺协会指南：儿童甲状腺结节及分化型甲状腺癌的管理

指南解读：美国甲状腺协会发布首部儿童甲状腺结节和甲状腺癌发布评估治疗指南

In order to promote best practice standards for the diagnosis and management of thyroid cancers, The American Thyroid Association (ATA) , the American Association of Clinical Endocrinologists, the National Comprehensive Cancer Network (NCCN), and the British Thyroid Association/Royal College of Physicians, previously published guidelines specifically addressing the evaluation, treatment and follow-up of thyroid nodules and differentiated thyroid cancer(DTC) in adults. In most cases, the evaluation, treatment and follow-up of children with thyroid neoplasia have followed adult guidelines. Heretofore, this approach resulted in a high proportion of cure, but required all children to undergo therapy that included total thyroidectomy followed by radioactive iodine(RAI) ablation with iodine-131. The goal was to eliminate any evidence of disease, documented by a negative whole-body RAI scan and, most recently, by an undetectable serum thyroglobulin (Tg) level. Unfortunately, recent studies with follow-up spanning several decades reveal an increase in all-cause mortality for survivors of childhood DTC, predominately due to second malignancies in children treated with radiation. These observations, coupled with a better understanding of the excellent prognosis associated with pediatric DTC, have now prompted the ATA to specifically address treatment of children with benign and malignant thyroid tumors.