Kada i kako posumnjati na karcinom štitnjače u djece i adolescenata
DOI:
https://doi.org/10.13112/pc.1159Ključne riječi:
Karcinomi štitnjače; Čvor štitnjače; Adolescent; Dijete; UltrazvukSažetak
Karcinom štitnjače rijetka je, ali najčešća maligna bolest endokrinog sustava u djece i adolescenata. Biološko ponašanje karcinoma štitnjače u ovoj skupini razlikuje se od onoga u odraslih bolesnika. U pedijatrijskoj populaciji karcinomi štitnjače često su veći u trenutku dijagnoze, češće pokazuju lokalnu invaziju te sklonost metastaziranju u cervikalne limfne čvorove i udaljene organe. Unatoč agresivnijoj prezentaciji i povećanom riziku od recidiva, dugoročna prognoza bolesti u djece i adolescenata ostaje izvrsna. U posljednjih nekoliko desetljeća bilježi se značajan porast incidencije karcinoma štitnjače u pedijatrijskoj populaciji. Najčešći histološki tip je papilarni karcinom štitnjače, dok su ostali oblici znatno rjeđi. Karcinom se najčešće dijagnosticira u adolescenciji i obično se prezentira kao asimptomatski čvor štitnjače. Iako su čvorovi štitnjače u djece rijetki, njihov maligni potencijal znatno je veći nego u odraslih, što zahtijeva poseban oprez u dijagnostičkom pristupu. Među najvažnijim rizičnim čimbenicima ističu se izloženost ionizirajućem zračenju, genetski sindromi, obiteljska pojavnost bolesti te određene autoimune bolesti štitnjače. Ultrazvučni pregled predstavlja temelj dijagnostičke obrade, pri čemu pojedina ultrazvučna obilježja značajno povećavaju sumnju na malignu bolest. Aspiracijska biopsija tankom iglom ostaje zlatni standard u procjeni sumnjivih čvorova. Pravodobno prepoznavanje rizičnih kliničkih i slikovnih obilježja ključno je za rano postavljanje dijagnoze, optimalno liječenje i očuvanje izvrsne prognoze karcinoma štitnjače u djece i adolescenata.
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