Varying impact of patient age on the rising rate of pediatric thyroid cancer: Analysis of NCDB database (2004–2017)

Published:November 29, 2022DOI:


      • We demonstrated that becoming an adolescent is associated with an increased risk to develop thyroid cancer.
      • There were more pediatric thyroid cancer cases in female (>80%) than male, which is suggestive of a hormonal association.
      • Most cases (∼90%) underwent total thyroidectomy, aligning with ATArecommendations, both prior to and after their publication.
      • To better discern the role of puberty on thyroid cancer development, standardized criteria are needed to categorize puberty.


      Pediatric thyroid carcinoma is on the rise. We sought to better characterize patient factors associated with this and evaluate for trends based on age groups. Additionally, we examined surgical management over time, and whether it aligns with recommendations made by the American Thyroid Association. Using the National Cancer Database (NCDB), we examined cases of thyroid cancer from 2004 to 2017, ages 1–18 years. We subdivided this cohort by age group: those <10y, 10-15y, and >15y. NCDB query yielded 5,814 cases. The annual proportion of total cases ranged from 3% to 8% for <10y, 31%–40% for 10-15y, and 52%–66% for >15y. 80–90% of cases in all age groups did indeed receive total thyroidectomy which is consistent with ATA guidelines. Our results verify an overall increase in pediatric thyroid cancer cases, occurring mostly in the 10–18 years old age range with the largest year-to-year increases in the >15y group.


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        • Cramer J.D.
        • Fu P.
        • Harth K.C.
        • Wilhelm S.M.
        Analysis of the rising incidence of thyroid cancer utilizing the SEER national cancer data registry.
        Surgery. 2010; 148: 1147-1153
        • Bernier M.-O.
        • Withrow D.R.
        • Berrington de Gonzalez A.
        • et al.
        Trends in pediatric thyroid cancer incidence in the United States, 1998-2013.
        Cancer. 2019; 125: 2497-2505
        • Golpanian S.
        • Perez E.A.
        • Tashiro J.
        • et al.
        Pediatric papillary thyroid carcinoma: outcomes and survival predictors in 2504 surgical patients.
        Pediatr Surg Int. 2016; 32: 201-208
        • Paulson V.A.
        • Rudzinski E.R.
        • Hawkins D.S.
        Thyroid cancer in the pediatric population.
        Genes. 2019; 10
        • Qian Z.J.
        • Jin M.C.
        • Meister K.D.
        • et al.
        Pediatric thyroid cancer incidence and mortality trends in the United States, 1973-2013.
        JAMA Otolaryngol Head Neck Surg. 2019; 145: 617-623
        • Miller K.D.
        • Fidler-Benaoudia M.
        • Keegan T.H.
        • et al.
        Cancer statistics for adolescents and young adults.
        CA Cancer J Clin, 2020. 2020; 70: 443-459
        • Cordioli M.I.C.V.
        • Moraes L.
        • Alves M.T. de S.
        • et al.
        Thyroid-specific genes expression uncovered age-related differences in pediatric thyroid carcinomas.
        Internet J Endocrinol. 2016; 2016
        • Francis G.L.
        • Waguespack S.G.
        • Bauer A.J.
        • et al.
        Management guidelines for children with thyroid nodules and differentiated thyroid cancer.
        Thyroid. 2015; 25: 716-759
        • Jin J.
        • Wilhelm S.M.
        • McHenry C.R.
        Incidental thyroid nodule: patterns of diagnosis and malignancy rate.
        Am J Surg. 2009; 197: 320-324
        • NIH
        Puberty and precocious puberty.
        in: National Institute of Child Health and Human Development. 2021
        • Biro F.M.
        • Huang B.
        • Crawford P.B.
        • et al.
        Pubertal correlates in black and white girls.
        J Pediatr. 2006; 148: 234-240
        • Biro F.M.
        • Lucky A.W.
        • Huster G.A.
        • et al.
        Pubertal staging in boys.
        J Pediatr. 1995; 127: 100-102
        • Lazar L.
        • Lebenthal Y.
        • Steinmetz A.
        • Yackobovitch-Gavan M.
        • et al.
        Differentiated thyroid carcinoma in pediatric patients: comparison of presentation and course between pre-pubertal children and adolescents.
        J Pediatr. 2009; 154: 708-714
        • da Silva Breder J.R.A.
        • Alves P.A.G.
        • Araújo M.L.
        • et al.
        Puberty and sex in pediatric thyroid cancer: could expression of estrogen and progesterone receptors affect prognosis?.
        Eur Thyroid J. 2022; 11
        • Machens A.
        • Lorenz K.
        • Nguyen Thanh P.
        • et al.
        Papillary thyroid cancer in children and adolescents does not differ in growth pattern and metastatic behavior.
        J Pediatr. 2010; 157: 648-652