Report of one case of malignancy among 17 autonomous thyroid nodules in children and adolescents

This study aimed to report a case of malignancy in a series of 17 autonomous thyroid nodules in children/adolescents.

We performed a retrospective analysis of patients with thyroid nodules between 2003 and 2018 who had the following characteristics: (i) low serum thyroid stimulating hormone (TSH); (ii) nodule(s) > 1 cm on ultrasonography; (iii) homogenous uptake on scintigraphy with radioiodine in the area corresponding to the nodule(s); (iv) suppression of the remaining parenchyma; and (v) age ≤ 18 years. The approach of the institution was to perform fine-needle aspiration in all children/adolescents with autonomous thyroid nodules, as well as surgery in all patients of this age group with toxic nodular disease.

Thirteen patients, 11 girls and 2 boys aged 9-18 years, had 17 autonomous nodules ranging in size from 1.4 to 5.5 cm. Cytology was benign in 11 nodules (64.7%) and histology confirmed the benign nature in all of them. Two nodules (11.7%) had non-diagnostic cytology and were also benign. Cytology was indeterminate in three other nodules (17.6%), with two adenomas and one follicular tumour of uncertain malignant potential. Finally, cytology was suspicious for malignancy in only one nodule (5.9%) for which the infiltrative follicular variant of papillary thyroid carcinoma was confirmed. The patient was a 13-year-old girl whose nodule exhibited highly suspicious ultrasonography features.

The incidence of malignancy in this series of 17 autonomous thyroid nodules in children/adolescents was 5.9%.