Thyroid nodules and differentiated thyroid cancer

The incidence of thyroid nodules and thyroid cancer has increased over the last several decades. This change is influenced by several factors, to include the status of iodine sufficiency, access to the health care system and, perhaps most significantly, the increased use of radiological imaging. Thorough evaluation of a thyroid nodule includes review of the patient's medical and family history, followed by thyroid ultrasound and fine-needle aspiration biopsy. Similar to adults, the majority of nodules in children are benign; however, there is a 3- to 5-fold higher risk that a nodule found in a pediatric patient (≤18 years) will be malignant when compared to an adult. Differentiated thyroid carcinoma (DTC) is the most common malignancy with approximately 90-95% being papillary thyroid carcinoma and the remainder follicular thyroid carcinoma. With proper evaluation and management, the prognosis for pediatric patients with DTC is excellent; however, the risk of treatment complications and recurrence is relatively high. The development of pediatric specific guidelines for the evaluation and management of thyroid nodules and DTC as well as the creation of centers with surgical and medical expertise is crucial in order to optimize care and gain a better understanding of factors that impact disease-specific morbidity.