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Natural History and Outcomes of Cytologically Benign Thyroid Nodules in Children
Christine E Cherella1, Henry A Feldman2, Monica Hollowell3
1Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts.
Insights
Most pediatric thyroid nodules are benign. This study followed 237 benign nodules in children, finding a low cancer rate (2.5%) with excellent outcomes. Nodule size and growth predict malignancy risk.
Area of Science:
- Pediatric Endocrinology
- Thyroidology
- Oncology
Background:
- Most pediatric thyroid nodules are cytologically benign.
- Limited data exist to guide the management of these nodules.
- Understanding their natural history is crucial for appropriate treatment decisions.
Purpose of the Study:
- To describe the natural history and outcomes of cytologically benign pediatric thyroid nodules.
- To identify factors associated with malignancy or nodule growth.
- To inform clinical management strategies for this population.
Main Methods:
- A cohort study was conducted at a multidisciplinary thyroid clinic.
- Consecutive pediatric patients (≤18 years) with benign nodules between 1998-2016 were included.
- Nodules were followed via ultrasound or resection, with a median follow-up of 3.4 years.
Main Results:
- Six nodules (2.5%) were diagnosed with thyroid cancer, all successfully treated.
- Malignancy risk was higher in nodules >4 cm (15.4%) or those that grew (6.0%).
- Nodule growth likelihood increased over time, influenced by size and cystic content.
Conclusions:
- Cytologically benign pediatric thyroid nodules have a low false-negative rate and excellent prognosis.
- Resection of larger nodules (>4 cm) and surveillance of smaller ones is recommended.
- Follow-up ultrasound at 12 months is appropriate, with potential extension to 24 months for large, cystic nodules.
Context:
Most pediatric thyroid nodules are cytologically benign, but few data exist to guide treatment.
Objective:
To describe the natural history and outcomes of cytologically benign, pediatric thyroid nodules.
Design:
Cohort study.
Setting:
Multidisciplinary thyroid clinic at an academic medical center.
Patients:
Consecutive pediatric patients (≤18 years old) with cytologically benign thyroid nodules evaluated between 1998 and 2016.
Results:
Cytologically benign nodules (N = 237) in 181 patients were followed by ultrasound (median follow-up, 3.4 years; range, 0.5 to 13.9 years) or to resection. Thyroid cancer was diagnosed in six nodules (2.5%), and all six patients were disease free after median follow-up of 4.9 years. Malignancy was more common in nodules >4 cm (15.4%; P = 0.037) or that grew during follow-up (6.0%; P = 0.048). The likelihood of nodule growth (±SE) was 15% ± 3%, 24% ± 4%, and 49% ± 10% at 6, 12, and 24 months, respectively. Among nodules >2 cm, those with ≥25% cystic content grew more slowly than nodules <25% cystic; nodules <2 cm grew similarly regardless of cystic content.
Conclusion:
Benign cytology in pediatric thyroid nodules has a low false-negative rate similar to that in adults, and prognosis is excellent in the rare cases of malignancy. Resection of nodules >4 cm, combined with surveillance of smaller nodules and repeated aspiration for growth, detects most false-negative results. Follow-up ultrasound in 12 months is appropriate for most cytologically benign pediatric nodules, but delaying surveillance up to 24 months may be reasonable in large, predominantly cystic nodules.
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