Thyroid carcinoma in children with graves’ disease

BACKGROUND: The combination of differentiated thyroid carcinoma (DTC) and Graves’ disease (GD) in childhood is extremely rare. According to the literature, the prevalence of DTC in adult GD is about 20%, and only a few cases have been described in children.

AIM: To determine the prevalence and describe the clinical morphologic features of thyroid carcinoma in children with GD.

MATERIALS AND METHODS: Retrospective study of 77 patients aged 10 to 17 years who underwent thyroidectomy for GD.

All patients underwent a comprehensive clinical-instrumental, cytologic and pathomorphologic study based on Endocrinology Research Centre in the period from January 2022 to September 2024.

RESULT: The incidence of DTC in children with GD was 10.4% (8 out of 77 patients), while in patients with nodules on the background of DTC – 21.7%. Interestingly, even in the absence of evidence of a thyroid nodule, the incidence of DTC was 5.5% and was detected only on pathomorphologic examination. According to the pathomorphologic stedy, the classical subtype of PTC was determined in 4 patients, papillary microcarcinoma – in 2 patients, follicular variant of PTC – in 1 patient, combination of follicular carcinoma and classical subtype of papillary carcinoma – in 1 child.

CONCLUSION: The high incidence of DTC in children with GD requires increased oncologic vigilance in their management. Fine-needle aspiration (FNA) of nodular masses belonging to EU-TIRADS categories 3-5 is a mandatory step in the examination. In the presence of nodular masses in the thyroid gland, surgical method of radical treatment of GD in children is preferable due to their high risk of malignancy.

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