Clinical features may help to identify children and adolescents with greatest risk for thyroid nodules

• Published in: Journal of endocrinological investigation Vol. 43; no. 7; pp. 925 - 934
• Main Authors: Allen, N., Desai, N., Song, C., Yu, J., Prasad, U., Francis, G.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-07-2020; Springer Nature B.V
• Subjects: Adolescent; Adolescents; Age of Onset; Child; Child, Preschool; Children; Cohort Studies; Endocrinology; Female; Glands; Goiter; Goiter - diagnosis; Goiter - epidemiology; Goiter - pathology; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Metabolic Diseases; Nodules; Original Article; Patients; Pediatrics - methods; Prognosis; Retrospective Studies; Risk Assessment; Surgery; Teenagers; Thyroid cancer; Thyroid carcinoma; Thyroid Neoplasms - diagnosis; Thyroid Neoplasms - epidemiology; Thyroid Neoplasms - pathology; Thyroid Nodule - diagnosis; Thyroid Nodule - epidemiology; Thyroid Nodule - pathology; Thyroid-stimulating hormone; Thyroiditis; Thyroiditis, Autoimmune - diagnosis; Thyroiditis, Autoimmune - epidemiology; Thyroiditis, Autoimmune - pathology; Ultrasonography; Ultrasound; Virginia - epidemiology; Virginia; Pediatrics; Thyroid nodules; Differentiated thyroid cancer; Thyroid
• ISSN: 1720-8386; 0391-4097; 1720-8386
• DOI: 10.1007/s40618-019-01176-6

Background
Thyroid nodules (TN) are detected in a small number of asymptomatic children and adolescents but are more frequently malignant (22–26%) than in adults leading some clinicians to perform thyroid ultrasound (US) for all children with goiter or autoimmune thyroiditis (AIT). Our study was designed to determine if suspicious clinical features predict the presence of TN in children with goiter or AIT so that US could be performed on those at highest risk.
Methods
This was a retrospective review of 223 children and adolescents with goiter or AIT evaluated at a single institution. US was not performed on all patients. It is our practice to define glands that are large, firm, or nodular to palpation as “suspicious”. Suspicious glands were interrogated by US and if TN was confirmed, this was further evaluated by fine-needle aspiration followed by surgery if indicated.
Results
The median age was 12.9 years with 74.4% female. TN were confirmed by US in 16.6% of all patients but only 4.8% of those with AIT. By univariate analysis, TN were more common in those with family history of TN or differentiated thyroid carcinoma (DTC), thyroid asymmetry, and lower thyrotropin (TSH) levels. Differentiated thyroid carcinoma (DTC) was identified in 10.8% of TN and 1.8% of all patients. Firmness was significantly more common in patients with DTC (
p
 = 0.0013).
Conclusion
TN were less common in those with AIT than reported in previous studies, suggesting that clinical features might fail to identify the majority of TN in patients with AIT. However, patients with asymmetric thyroid and a family history of TN or DTC have greatest risk for TN.