Thyroid nodules in children: what should be a minimal work-up preceding surgery?

Area of Science:

• Pediatric Endocrinology
• Surgical Oncology
• Diagnostic Imaging

Background:

• Thyroid nodules in children often require extensive and costly evaluations.
• Identifying a minimal necessary clinical workup is crucial for efficient surgical planning.

Purpose of the Study:

• To determine the minimal clinical workup for euthyroid children with thyroid nodules requiring surgical management.
• To establish an appropriate surgical management plan based on essential diagnostic steps.

Main Methods:

• A case-control study analyzed data from pediatric thyroid nodule surgeries over ten years.
• Variables included clinical presentation, lab tests, imaging, fine-needle aspiration (FNA) findings, and pathology.
• Preoperative workup costs were estimated.

Main Results:

• The study included 24 children (19 female, 5 male; average age 14).
• Malignancy rate was 54%, predominantly papillary cell carcinoma (PCC), especially in males.
• Fine-needle aspiration (FNA) showed 75% accuracy, with no false positives for malignancy.

Conclusions:

• A minimal workup algorithm is essential for pediatric thyroid nodules.
• Palpable nodules with lymphadenopathy warrant immediate FNA.
• For nodules without lymphadenopathy, ultrasound (US) followed by FNA if persistent/growing is recommended; US-guided FNA is optimal for small or difficult-to-palpate nodules.