Endocrine Abstracts

In a modern world of ultrasound (US) technology, thyroid nodules are diagnosed 5–10 times more frequently than used to be the case by palpation. Thus, the question of work-up and management is of major importance, especially in asymptomatic incidental findings. This question is very pertinent in pediatric cases, when imaging is performed for non-thyroid indications.

In the adult population, thyroid nodules are detected by US in 19 to 67% of the population. In the adolescents and young adult population, estimates from US examination suggest that 13%, and among young children, up to 5%, have thyroid nodules.

Although thyroid nodules are less common in children, it is of major concern that they are almost five-fold more likely to be malignant in children than in adults (26.4% vs. approximately 5%).

We must always keep in mind that a child and even an adolescent, is not simply a miniature adult, and thus approach and management are not identical.

The aim of this review is to discuss the major issues in evaluating and treating thyroid nodules in children and adolescents, and to compare pediatric evaluation and treatment with that of the adult population with thyroid nodules.

The following questions will be discussed: Do we need routine surveillance to detect thyroid nodules as early as possible in high-risk patients? Who are high risk pediatric patients? Do all nodules need FNA or are there clinical and sonographic features that will help to identify those in need of FNA? If the FNA appears benign, is this sufficient to allow life-long follow up without surgical removal? What if we incorrectly diagnose a thyroid cancer as a benign lesion: Will that negatively impact long-term survival? Do benign thyroid nodules in children become or predispose to malignant lesions later in life? Does size count? How should apparently benign lesion be treated in children?