Updates in Management of Differentiated Thyroid Cancer in Pediatric Patients; A Systematic Review and Meta-Analysis
Authors: Mostafa Abd Elrazek Mostafa Mohamed , Elhameed Waleed Ibrahim Abd , Al- Baghdady Ayman Ahmed Ali , Nageeb Ramy Mikhael , Elhameed Hazem Samir Abd 
Published: November 2024

Abstract

Background
Thyroid cancer is a rare pathology in childhood and adolescence being responsible for 1.5–3% of all carcinomas in this age group. Such as the adults, the differentiated thyroid carcinoma is the most commonly found, especially the papillary carcinoma. In this population, age, family history of thyroid disease and radiation exposure are very important factors as already shown in various series. The current treatment recommendation is the total thyroidectomy followed by radioiodine therapy, based on good response and high disease-free survival rate for this age group. However, many authors question the aggressiveness of this treatment given the long lifespan of these patients and long-term complications of high doses of radioiodine. This study aims to evaluate the initial therapeutic approach for children with differentiated thyroid cancer (DTC) regarding surgery, adjuvant therapy.

Objectives
to evaluate the updates of management of differentiated thyroid cancer regarding radioactive iodine administration after total thyroidectomy.

Methods
Meta-analysis study and a systematic review will be performed in accordance with the PRISMA and PICO guidelines. An initial search will be carried out using online databases: PubMed/MEDLINE, Google Scholar, Egyptian Knowledge Bank and Science direct. Abstracts of articles identified using the search strategy above will be viewed, and articles that appear to fulfil the inclusion criteria will be retrieved in full. Each article identified will be reviewed and categorized into one of the following groups: included or excluded. When there will be a doubt, a second reviewer will assess the article and a consensus will be reached. Inclusion criteria will be: 1) Include pediatric participants (males &lt; 14 years old and females &lt; 16 years old) who had been diagnosed as differentiated thyroid cancer and treated. 2) Provide sufficient details on the above outcome measures to allow comparison across studies. 3) Report quantitative data. 4) Be written in English language. 5) Be published in full-text and in a peer-reviewed journal.

Results
Review Manager Version 5.4 software (Cochrane Collaboration) was used to analyze the data. To account for the differences between patients administered by radioactive iodine therapy (RAIT) and those with no RAIT, risk differences (RDs) with 95% confidence intervals (CIs were used to analyze and random-effects meta- analyses were conducted using crude data and data statistically adjusted for confounders with 95% confidence intervals (95% CIs). For all analyses, p &lt; 0.05 was considered statistically significant. The initial search identified 1240 potentially eligible citations. Among these, 580 were identified as duplicates and thus removed, leaving 660 records. The reviewers after the evaluation of their titles and abstracts of these studies removed 654 citations. The remaining 6 articles included a total of 743 patients (656 treated with RAI and 693 not treated with RAI) and were the basis of the present meta-analysis. All the studies were retrospective. Two studies were performed in Italy, one in Korea, one in The Republic of Croatia, one in Turkey and one study in the USA. The mean age of the included studies was 14.105 ± 1.03 years. There were 204 males and 539 females with a mean follow-up duration of 83.09 months.

Conclusion
The administration of radioactive iodine aims to reduce the recurrence rate of differentiated thyroid cancer after total thyroidectomy. Also patient with radioactive iodine showed less incomplete structural response.