BACKGROUND
Thyroid cancer occurs in children and adolescents. Fortunately, children and adolescents usually have an excellent response to treatment, as is often seen with adults. The vast majority of children and adolescents have a very low risk of recurrence of their thyroid cancer. With the excellent response to treatment, less aggressive treatment of the thyroid cancer at the time of initial diagnosis is recommended. This includes removal of only the thyroid lobe containing the cancer (lobectomy) as opposed to removing the entire thyroid gland and a decrease in the use of radioactive iodine therapy. Thus, determining the appropriate means and duration of posttreatment follow up is very important.

Although postoperative follow-up with neck ultrasound poses little physical risk, potential harm from overuse can occur because of detection of false-positive or unclear findings, which trigger further investigation, health care expenditures, and patient anxiety. Data on the use of neck ultrasound follow-up in children are particularly lacking. This study examined the risk of thyroid cancer recurrence in children and adolescents and the use of neck ultrasound to follow thyroid cancer low risk patients.

THE FULL ARTICLE TITLE
Rao S, et al. Utility of ultrasound surveillance for thyroid cancer in children. Thyroid 2025;35(4):406-414; doi: 10.1089/thy.2024.0624. PMID: 39888311.

SUMMARY OF THE STUDY
This study examined all patients ≤18 years of age with thyroid cancer at a single center classified as either ATAExcellent reponse or ATA-Indeterminate response to therapy. The response to therapy was assessed 6–18 months after lobectomy or total thyroidectomy, with or without treatment with radioactive iodine, and then followed with ultrasound. Study end points were development of cancer recurrence in the neck detected by ultrasound.

Between 1998 and 2022, 112 children (78% female, average age at diagnosis, 15 years) were included, with 87% having papillary thyroid cancer. Some 15% of patients were classified initially as ATA-High postoperative risk for cancer recurrence, with the rest ATA-Low risk or ATA-Intermediate risk. The average ultrasound follow-up was 6.4 years, over which time 683 ultrasound studies were performed (around one per patient per year).

None of the 61 patients with a ATA-Excellent risk developed recurrence of thyroid cancer in the nodes of the neck over an average of 6 years of follow-up. However, 29% of these patients had a false-positive ultrasound finding, and 2 required thyroid biopsy for clarification. By contrast, 18% of patients with a posttherapy ATA-Indeterminate response developed thyroid cancer recurrence over an average of 6 years of follow-up, which represented one third of those with at least one indeterminate or abnormal ultrasound finding during follow-up. Of note, 7 of these 9 recurrences were detected by ultrasound.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
In children with ATA-Excellent response to therapy in this study, follow-up with ultrasound had very limited utility to detect recurrent thyroid cancer, with all abnormal ultrasound findings found to be negative for cancer. By contrast, recurrences were detected in ATA-Indeterminate patients using ultrasound. Thus, this study suggests that the risks of unnecessary invasive diagnostic procedures following false positive ultrasound findings may outweigh the perceived benefits of annual ultrasound screening in these low-risk patients. More studies are required to determine the role of ultrasound follow-up in children and adolescents with low risk thyroid cancer.

— Alan P. Farwell, MD

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