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Who Is Diagnosing Pediatric Thyroid Nodules? A Tertiary Children's Hospital Review
Joy M Justice1, Janavi Sethurathnam1, Nanda Nayak1
1Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Insights
Primary care providers are key in diagnosing pediatric thyroid nodules, often detected via physical exam. Their diagnoses are linked to larger nodule sizes and more frequent malignancy findings compared to other specialists.
Area of Science:
- Pediatric Endocrinology
- Oncology
- Diagnostic Imaging
Background:
- The incidence of pediatric thyroid cancer is rising.
- Understanding the role of different healthcare providers in diagnosing pediatric thyroid nodules is crucial for optimizing patient care.
- Limited data exists on how provider type influences nodule detection and subsequent management.
Purpose of the Study:
- To analyze the types of healthcare providers diagnosing pediatric thyroid nodules.
- To investigate the impact of diagnosing provider type on nodule size and clinical management.
- To examine diagnostic methods used by different provider types.
Main Methods:
- Retrospective chart review of pediatric patients (0-17 years) diagnosed with thyroid nodules between 2006 and 2023.
- Analysis of diagnosing provider type, diagnostic methods, nodule size, clinical management, and final diagnosis.
- Comparison of findings based on provider specialty (e.g., primary care, endocrinology, radiology).
Main Results:
- Primary care providers diagnosed the majority of nodules (43.0%), often via physical exam.
- Nodules diagnosed by primary care providers were larger (median 1.50 cm) and more frequently led to biopsy, surgery, or a malignant diagnosis compared to those diagnosed by endocrinologists or radiologists.
- The proportion of incidentally diagnosed nodules by radiologists increased significantly after 2017.
Conclusions:
- Primary care providers play a vital role in the initial detection of pediatric thyroid nodules.
- Physical examination remains an essential tool for identifying significant thyroid pathology in children.
- Further research is needed to explore factors like socioeconomic status and geographic location affecting nodule management.
Objective:
The incidence of pediatric thyroid cancer has increased. Little is documented about which providers are diagnosing pediatric thyroid nodules and how this impacts care. Our objective was to analyze how nodules are identified and how diagnosing provider type impacts nodule size and management.
Study Design:
Retrospective chart review.
Setting:
Tertiary care children's hospital.
Methods:
Pediatric patients (aged 0-17) with at least one thyroid nodule diagnosed between 2006 and 2023 were reviewed. Diagnosing provider type, diagnostic method, nodule size, clinical management, and final diagnosis were analyzed.
Results:
The study included 351 patients. Primary care providers diagnosed the largest proportion of nodules (43.0%), followed by incidental nodules by radiologists (24.2%). The proportion diagnosed by radiologists increased from 12% to 31% after 2017 (P < .001). Primary care providers were more likely to use physical exam than pediatric endocrinologists (65% vs 42%, P = .004), who more often used ultrasound (56% vs 37%, P = .02). Primary care providers diagnosed nodules with a median diameter of 1.50 cm, larger than that of pediatric endocrinologists and radiologists, both 0.8 cm (P = .01, P < .001). Compared to patients diagnosed by radiologists, patients diagnosed by primary care providers more often underwent biopsy (P = .02) or surgery (P < .001) and received a malignant diagnosis (P = .001).
Conclusion:
Primary care providers play a key role in detecting pediatric thyroid nodules, and a physical exam is vital in identifying significant pathology. Radiologic incidental nodules increased in frequency over our study timespan. Future research should consider the impact of socioeconomic status or geographic location on nodule size and management.
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