Thyroid carcinoma in childhood in Great Britain.

Carcinoma of the thyroid in childhood is a rare condition, and after an extensive search only seven cases have been found in Great Britain. In 1920 Hughes dissected enlarged cervical glands in a 13-year-old girl; the glands were found to be invaded by papilliferous thyroid carcinoma and thyroidectomy was done. The child was well three months later. Moncrieff and Poynton (1929) reported the case of an 11-year-old girl who had had a swelling of the neck since the age of 4, with recent enlargement and respiratory obstruction. Removal was attempted but the child died; post-mortem examination showed a carcinoma of the thyroid, partly solid and partly papilliferous, and infiltrating the trachea. Taylor and Wilkinson (1935) reported a 6-year-old girl who had a cough for five weeks, dyspnoea, but no haemoptysis, after a cold. There were small, discrete, hard cervical glands, and a radiograph of the chest showed appearances suggestive of miliary tuberculosis but the Mantoux reaction was negative. During the next two months the glands enlarged and fused, producing stridor, increasing dyspnoea from tracheal compression and eventually death from asphyxia. Post-mortem examination showed a partly solid, partly papillary carcinoma of the thyroid, infiltrating the trachea and invading the cervical glands. The lungs were studded with metastatic deposits. d'Abreu (1936) treated a girl of 16 who had had a swelling in the neck associated with a 'choking' feeling for three months; biopsy of a gland in the left anterior triangle showed infiltration with adenocarcinoma. Subsequently left hemithyroidectomy and dissection of the remaining glands was done, and when seen nine years later she was married, with a family, and had had no recurrence. Joll (1936) removed an adenocarcinoma of the thyroid in a 16-year-old girl. Three courses of radiotherapy, with a total dose of 2,400 r on each occasion, were given and she has remained well. Goldie (1950) examined an operation specimen from a 12-year-old boy; he had had a swelling of the thyroid excised one year before, and the swelling had recurred. The gland was greatly enlarged and both lobes contained multiple nodules; some of these were composed of undifferentiated epithelial cells, some showed papillary structure and others mixed solid and papillary elements. Atypical cells and mitoses were found towards the periphery of the nodules. East (1954) treated a 14-year-old girl who had had a large gland in the left upper cervical chain for four years; the gland was excised and shown to be infiltrated with papillary adenocarcinoma. Subsequently total thyroidectomy was done, and the left lobe contained a papillary and tubular colloidsecreting adenocarcinoma. Professor Smithers subsequently investigated her with radioactive iodine but found no reason for treating her with it. Three months after operation enlarged cervical glands were found and removed from both sides. Two months later enlarged supraclavicular glands were noted, and Professor Smithers gave a course of radiotherapy, 3,700 r in 39 days. The child has since remained well, with no recurrence after one year. Winship and Chase (1953), have commented on the paucity of reported cases of carcinoma of the thyroid in children in western Europe, and could collect only 42. Winship (1951) also indicated that inadequate follow-up and deficient hospital records hinder the evaluation of therapy for a condition of high mortality in children, emphasizing the importance of early diagnosis and the radical removal of all nodular goitres. It is therefore felt that the following case should be recorded.