Presentation of thyroid nodules in children
Background: Maintenance of normal levels of thyroid hormones is crucially important to the body's metabolism and development, especially in children and adolescents. There are many thyroid disorders including nodules that result in disease. The presence of a thyroid nodule is clinically important because of a concern for abnormal thyroid function and of a risk of malignancy. Although nodules are not commonly presented in children, nodules in pediatric populations have been associated with a greater risk of malignancy and with more aggressive cancer behavior. The primary management goals for evaluating thyroid nodules in children are to identity those of malignant nature and to provide appropriate treatment early in the disease. Objective: By studying an unusually large pediatric population seen at the Thyroid Clinic at Children's Hospital Boston from July 1998 to March 2011, this present study was designed to first determine the rate of thyroid cancer in children, second to identify the predictive value of patient and nodular features for cancer risk and third to identify the methods in which childhood nodules are first presented. Methods: Children's Hospital Boston and the Brigham and Women's Hospital collaborated to create a multidisciplinary thyroid nodule clinic to treatment of nodules in pediatric patients. Patient and nodule features are regularly recorded for all patients seen at the clinic. A retrospective chart review of 126 patients was conducted over 15 years. Analysis examined the predictive value of several patient and nodular features associated with cancer. In addition, a prospective telephone interview was completed in 21 patients to determine how nodules are first detected before subspecialty referral. Results: 126 children ranged in age from 5.4 to 18.9 years (mean 15.1) at the initial nodule clinic visit and presented with 140 sonographically discrete thyroid nodules. UG-FNAB experience of such nodules showed that this technique can be safely implemented in children and that the most common final cytology category was benign (64%). Surgical resection was performed in 42% of the 140 nodules and of these, 27 were confirmed to be thyroid cancer by surgery. Overall, 21% of children in our series were diagnosed with thyroid cancer of PTC and follicular thyroid cancer subtypes. Additionally, our prospective phone study found that the most common method of nodule detection in 21 patients was by the patient or a family member without formal medical training. Conclusion: FNAB is an effective and safe in children as in adults for definitive diagnosis of thyroid nodules. When used with ultrasonography, these techniques prevent unnecessary or inappropriate thyroid surgery in children. Although the initial presentation of childhood thyroid nodule is inconsistently documented in patient charts, this information may be an important determinant of thyroid cancer outcomes in children and could suggest necessary changes to current pediatric primary care.
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