Imaging and Imaging-Based Management of Pediatric Thyroid Nodules

Area of Science:

• Pediatric Endocrinology
• Radiology
• Oncology

Background:

• Thyroid nodules are less common in children than adults.
• Childhood thyroid nodules have a higher malignancy risk and unique management needs.
• They represent a distinct clinical entity requiring specialized imaging recommendations.

Purpose of the Study:

• To review imaging and management strategies for pediatric nodular thyroid disease.
• To highlight the unique features of thyroid nodules in children.
• To provide specific imaging recommendations for this population.

Main Methods:

• Comprehensive review of clinical evaluation, including history and physical examination.
• Discussion of laboratory and radiologic evaluations, emphasizing ultrasonography (US).
• Evaluation of advanced imaging techniques like US elastography, fine-needle aspiration biopsy (FNAB), scintigraphy, 18F-FDG-PET, CT, and MRI.

Main Results:

• Ultrasonography is the primary diagnostic imaging test for all pediatric patients.
• US elastography aids in assessing nodule firmness and malignancy risk.
• Fine-needle aspiration biopsy (FNAB) is the gold standard for differentiating benign from malignant nodules.
• Thyroid scintigraphy offers valuable functional information for diagnosis and follow-up.
• 18F-FDG-PET, CT, and MRI are not routinely recommended for initial evaluation.

Conclusions:

• Pediatric thyroid nodules require a distinct diagnostic and management approach due to their unique characteristics and higher malignancy potential.
• A thorough workup, starting with clinical assessment and ultrasonography, is crucial.
• While FNAB remains the mainstay, other imaging modalities play supportive roles in specific scenarios.