Thyroid cancer in children occurs about 10 times a year in the Netherlands. In most cases, thyroid cancer can be treated very well. Usually a lump is discovered in the neck and a child first comes to the WKZ for diagnosis and treatment. An ultrasound of the thyroid gland and a puncture of the nodule will follow. If it turns out to be thyroid cancer, treatment is continued in close cooperation with the Máxima Center. This means first an operation on the thyroid gland, followed by treatment with radioactive iodine. The child then has to take thyroid hormone for life.
The new guideline was presented on December 15 at a webinar with international experts. Hanneke van Santen, pediatric endocrinologist and chair of the guideline, is associate professor at UMCU and co-principal investigator at the Máxima Center. Together with Chantal Lebbink, PhD student and coordinator of the guideline, she looks back on a historic moment. 'Although the number of children with thyroid cancer is relatively low - about 10 children a year in the Netherlands - we were able to make important recommendations,' says Hanneke. ‘The most important: centralization of care is really necessary, especially to avoid the surgical late effects. In addition, our advice is not to approach a thyroid nodule (lump) too aggressively in terms of treatment; it is usually benign. Of course, we want to avoid overtreatment. Also, the new guideline is more restrained in the use of radioactive iodine in the treatment of thyroid cancer. This is also becoming increasingly important for other countries in Europe.'
Chantal Lebbink says: 'We see that the survival rates for children are very good, but many children suffer from late effects such as salivary gland damage, parathyroid gland damage or a hoarse voice. The number of late effects decreases as the treatment team becomes more experienced. Children from all over the country should be referred to a recognized center of expertise for children with thyroid cancer, as is present in our Máxima/WKZ/UMCU.'
Recognized center of expertise
Hanneke van Santen adds: 'You only get this thyroid surgery once in your life and it is best done by a surgeon who does this often. In our case it is done by the adult endocrine surgeon at the UMCU together with the pediatric surgeon at the Máxima Center; that way you get the best outcome. But the same applies to the whole team; with experience you can make better decisions about the treatment and follow-up of a child and, for example, the amount of thyroid hormone it needs. In addition, you can do better research if you treat the whole cohort. This applies to both clinical studies and preclinical studies because it gives you the opportunity to collect material for genetic studies.'