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Nodular thyroid disease in children and adolescents
1Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA 17822, USA.
Insights
Thyroid nodules in children are rare but carry a significant risk of malignancy. All solitary thyroid nodules in pediatric patients should be surgically removed unless fine-needle aspiration confirms benign histology.
Area of Science:
- Pediatric Endocrinology
- Surgical Oncology
- Thyroidology
Background:
- Thyroid nodules in children are exceptionally rare.
- While often asymptomatic, pediatric thyroid nodules warrant significant attention due to the elevated risk of malignancy compared to adults.
- Early and accurate diagnosis is crucial for appropriate management.
Purpose of the Study:
- To review the diagnostic workup and surgical management of thyroid nodules in pediatric patients.
- To assess the incidence of benign versus malignant thyroid nodules in surgically managed cases.
- To provide recommendations for the surgical approach to pediatric thyroid nodules.
Main Methods:
- Retrospective review of medical records for patients aged 20 years and younger with surgically managed thyroid nodules.
- Analysis of diagnostic procedures including serum thyroid studies, radiologic evaluation, and fine-needle aspiration (FNA).
- Evaluation of surgical outcomes and recommendations based on pathology.
Main Results:
- Out of 71 surgically managed pediatric thyroid nodules, 45 were benign and 26 were malignant.
- The study details the institution's diagnostic approach for these rare cases.
- Malignancy risk underscores the importance of thorough evaluation.
Conclusions:
- All solitary thyroid nodules in children should be surgically excised unless FNA definitively proves benign histology.
- Partial thyroidectomy may suffice for benign nodules.
- Total thyroidectomy is recommended for malignant pediatric thyroid nodules, despite no statistical survival difference, for comprehensive management.
Abstract:
Thyroid nodules in children are extremely uncommon. Most thyroid nodules, both benign and malignant, present as asymptomatic neck masses. A thyroid nodule in a child is significant because of the risk of malignancy. A review of medical records at our institution demonstrated 71 patients 20 years of age and younger with surgically managed thyroid nodules, of which 45 were benign and 26 were malignant. Our diagnostic workup, including serum thyroid studies, radiologic evaluation, and fine-needle aspiration, is discussed. Because of the possibility of malignancy, we recommend that all solitary thyroid nodules be excised in children unless fine-needle aspiration definitively determines a benign histology. The extent and type of surgical management is controversial and is still subject to much debate. Partial thyroidectomy appears adequate for benign disease, but even though there is no statistical difference in survival, we recommend total thyroidectomy for the management of malignant disease.