Clinical Aspects of Pediatric Thyroid Cancer and Follow-Up of Patients in Belarus Following the Chernobyl Accident

Early diagnosis of thyroid cancer in children exposed to radionuclides is clinically important for good outcome. Ultrasound examination commonly detects thyroid cancer as a hypoechoic nodule with inhomogeneous structure and irregular outline, or less frequently as a diffuse formation; regional lymph nodes are often enlarged. Post-Chernobyl thyroid cancer is quite aggressive at presentation, including neck lymph node involvement in 73.7% and distant metastases in 11.1%. Outcomes are generally favorable after total thyroidectomy and appropriate radioiodine therapy. The overall survival was 96.9% with a median follow-up of 15.4 years, 1.9% of patients died. The most frequent causes of death were suicide and trauma. The prevalence of second primary malignancies in this unique cohort is 1.4%. Future research is important to evaluate the role of radiation (from Chernobyl and therapeutic procedures), genetic predisposition, and other ecological factors in the long-term results of treatment, paying particular attention to disease progression and second malignancy.