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Published on: March 17, 2023
Follow-up of parenchymal changes in the thyroid gland with diffuse autoimmune thyroiditis in children prior to the
D Januś1,2, M Wójcik3,4, A Taczanowska5,6
1Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Krakow, Poland. dominika.janus@uj.edu.pl.
Insights
Ultrasound (US) follow-ups can identify thyroid parenchymal changes in children with autoimmune thyroid disease (AIT) that may precede papillary thyroid carcinoma (PTC) development. This highlights the potential of US monitoring for early PTC detection in pediatric AIT patients.
Area of Science:
- Pediatric Endocrinology
- Diagnostic Imaging
- Oncology
Background:
- Autoimmune thyroid disease (AIT) in children can present with varied ultrasound (US) findings.
- Papillary thyroid carcinoma (PTC) development in AIT patients without initial nodules is a concern.
- Characterizing pre-malignant parenchymal changes is crucial for early detection.
Purpose of the Study:
- To evaluate ultrasound (US) follow-up outcomes in pediatric autoimmune thyroid disease (AIT) patients.
- To identify thyroid parenchymal changes preceding papillary thyroid carcinoma (PTC) development.
- To assess the utility of US monitoring for PTC risk stratification in children.
Main Methods:
- Retrospective review of thyroid US scans in 327 pediatric AIT patients.
- Analysis of 11 patients diagnosed with PTC, focusing on six who developed it during follow-up.
- Detailed examination of parenchymal echogenicity and fibrosis patterns over time.
Main Results:
- No initial nodules were found in patients who later developed PTC.
- Progressive echogenicity increase in thyroid parenchyma was observed during US follow-up.
- Papillary thyroid carcinoma (PTC) developed a mean of 2.9 years after the last nodule-free US scan.
Conclusions:
- Sonographic follow-up is a promising strategy for detecting PTC susceptibility in children with AIT.
- Monitoring parenchymal changes may aid in identifying high-risk individuals.
- Further research is warranted to validate US follow-up for pediatric PTC risk assessment.
Purpose:
To present the outcomes of ultrasound (US) follow-ups in children with autoimmune thyroid disease who did not have a thyroid nodule on admission but developed papillary thyroid carcinoma (PTC) and to characterize the parenchymal changes in the thyroid gland prior to the development of PTC.
Methods:
A retrospective thyroid US scan review of 327 patients diagnosed with AIT was performed. Forty patients (40/327, 12.2%) presented nodular AIT variant with a normoechogenic background. Eleven patients (11/327, 3.4%, 11/40, 27.5%) presenting this variant were diagnosed with PTC (nine females-mean age 15.3 years; two males aged 11 and 13 years). In five of 11 patients, the suspicious nodule that was later confirmed to be PTC was detected on the initial US at presentation. For the remaining six females (6/11) who developed PTC during the follow-up, we retrospectively analysed their US thyroid scans and these patients were selected for analysis in this study.
Results:
On admission, the US evaluation revealed an enlarged normoechogenic thyroid gland in three patients and a hypoechogenic thyroid gland with fibrosis as indicated by irregular, chaotic hyperechogenic layers in three patients. No thyroid nodules were identified. Ultrasound monitoring revealed increasing echogenicity of the thyroid parenchyma during the follow-up. PTC developed in a mean time of 4.6 years (1 9/12-7 4/12 years) since referral to the outpatient thyroid clinic and 2.9 years (6/12-6 9/12) since the last nodule-free US thyroid scan.
Conclusions:
Sonographic follow-up assessments warrant further exploration as a strategy to determine PTC susceptibility in the paediatric population.
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