Can Delphian nodes be used to reliably predict thyroiditis in the paediatric population?

Delphian (level VI) lymph nodes are often linked to head and neck malignancy, but their relationship with thyroiditis is less well described. Ultrasound is used in the assessment and workup for thyroiditis, but thyroid appearances can be variable and non-specific. The presence of a Delphian lymph node may help to determine the aetiology of inflammatory thyroid disease.

To investigate whether assessing Delphian lymph nodes on ultrasound can help predict the diagnosis of thyroiditis in children.

Retrospective review of scans from 70 children (1-17 years old) carried out by a single radiologist at a tertiary paediatric centre. The presence or absence of Delphian lymph nodes was assessed, as well as the thyroid size/volume, echogenicity and vascularity. Biochemical markers, where applicable, and clinical diagnoses were obtained and matched up to radiological findings. Markers included thyroid function tests (TFTs) as well as serum thyroid peroxidase antibody and thyroid receptor antibody.

Twenty-four patients had Delphian lymph nodes identified on ultrasound. There was statistical significance between the presence of Delphian lymph nodes and heterogeneous thyroid architecture (p < 0.001), thyroid enlargement (p = 0.002) and increased thyroid vascularity (p < 0.001). Although no significant association was identified between the size of the Delphian lymph node and the thyroid appearances on ultrasound or the biochemical results, there was a significant association between the presence of Delphian lymph nodes and the clinical diagnosis.

There is a significant association between the presence of Delphian lymph nodes on ultrasound with findings in thyroiditis. These include the presence of key biochemical markers and abnormal thyroid appearances on ultrasound - increased heterogeneity, size and vascularity.