Benign thyroid nodules in pediatric patients: determining best practices for repeat ultrasound evaluations

Area of Science:

• Pediatric Endocrinology
• Thyroidology
• Oncology

Background:

• Current American Thyroid Association (ATA) guidelines for benign thyroid nodules in children rely on adult data.
• Significant physiological differences exist between pediatric and adult thyroid nodules.
• Optimal follow-up intervals for pediatric benign thyroid nodules require specific investigation.

Purpose of the Study:

• To determine the appropriate follow-up schedule for pediatric patients with benign thyroid nodules diagnosed via fine needle aspiration (FNA).
• To evaluate the growth patterns and outcomes of benign thyroid nodules in children.

Main Methods:

• Retrospective chart review of patients under 19 years old diagnosed with benign thyroid nodules via FNA between 2003 and 2013.
• Analysis of initial and follow-up ultrasound findings, nodule size, and patient demographics.
• Review of surgical pathology results for patients who underwent thyroidectomy.

Main Results:

• 43 pediatric patients with benign FNA cytology were identified; average age 15.6 years, 91% female.
• Initial ultrasound characteristics included average nodule size of 2.5 cm, with varying rates of calcifications, hyperemia, hypoechogenicity, and lymphadenopathy.
• Four patients showed significant nodule growth; one patient with papillary thyroid carcinoma (PTC) initially had a decreasing nodule size before increasing over 4.5 years. 33% of nodules were surgically removed, with final pathology revealing benign cytology, follicular adenoma, or PTC.

Conclusions:

• Most pediatric benign thyroid nodules do not exhibit significant growth within the first year.
• A follow-up ultrasound at one year is suggested for low-risk pediatric patients with benign thyroid nodule cytology.
• This approach aids in monitoring nodule behavior and timely detection of potential malignancies like PTC.