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The thyroid nodules in kids study (ThyNK study): An evaluation of clinical practice variation
AlGhalya Al Maawali1, Cyrus Matheson2, Robert Baird1
1Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, Vancouver, BC, Canada.
Insights
Clinical practice variation exists in pediatric thyroid nodule management despite American Thyroid Association (ATA) guidelines. Complexity and heterogeneity of cases contribute to persistent deviations from established protocols.
Area of Science:
- Pediatric Endocrinology
- Surgical Oncology
- Clinical Practice Guidelines
Background:
- Thyroid nodules are increasingly diagnosed in children.
- Standardized management protocols are essential for optimal patient outcomes.
- The 2015 American Thyroid Association (ATA) guidelines offer a framework for pediatric thyroid nodule care.
Purpose of the Study:
- To evaluate the current management of pediatric thyroid nodules.
- To assess clinical practice variation (CPV) in relation to the 2015 ATA guidelines.
- To identify factors contributing to deviations from established guidelines.
Main Methods:
- Retrospective analysis of 86 pediatric patients with thyroid nodules (2007-2017).
- Data collection included demographics and disease-specific information.
- Evaluation of CPV and adherence to ATA guidelines.
Main Results:
- 47% of patients underwent surgery; 17% had malignant pathology (73% papillary carcinoma).
- Preoperative ultrasound was absent in 15% of surgical cases; preoperative cytology was missing in 26%.
- CPV was linked to complex cases, direct surgical decisions, and rare pathologies.
Conclusions:
- The ATA guidelines provide a useful framework for managing pediatric thyroid nodules.
- Persistent clinical practice variation is observed due to patient and disease complexity.
- Further refinement of guidelines or implementation strategies may be needed.
Purpose:
The purpose of this study was to evaluate the management of thyroid nodules in children and assess clinical practice variation (CPV) using the 2015 American Thyroid Association (ATA) guidelines as a standard.
Methods:
Pediatric patients presenting to a tertiary care pediatric centre with a thyroid nodule from 2007 to 2017 were retrospectively analyzed. Demographic and disease specific information were collected. CPV and adherence to ATA guidelines were explored.
Results:
Of 86 patient records reviewed, 47 (55%) were managed operatively (mean age 14.4, 59F:27M). Fifteen patients (17%) had malignant pathology, and 11/15 (73%) were papillary carcinoma. Of the 47 operative patients, 7 (15%) had no preoperative ultrasound, and 12 patients (26%) did not have preoperative cytology. All patients with low TSH had scintigraphy appropriately performed, and 1 patient with high/normal TSH did not have a preoperative FNA obtained. All differentiated thyroid cancers were appropriately managed with hemithyroidectomy or total thyroidectomy based on pathology. Where CPV from the guidelines was noted, it was associated with complex presentation, the surgeon's decision to proceed to surgery directly, and/or rare pathologies.
Conclusion:
The ATA guidelines provide a valuable framework for the management of pediatric thyroid nodules, but CPV persists given patient/disease complexity and heterogeneity.
Type Of Study:
Case Series with No Comparison Groups.
Level Of Evidence:
Level VI: Case series with no comparison groups.
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