Endocrine Abstracts

Introduction: Although thyroid nodules (TN) are less common in children than in adults, the risk of malignancy is much higher in pediatric age and therefore representing greater concern in this age group.

Objective: Evaluate a cohort of pediatric patients with TN and search differences between subjects with malignant and benign TN regarding sex, age, compressive symptoms, cervical ultrasound characteristics, family history of differentiated thyroid cancer (FHDTC), radiation exposure and previous/coexisting thyroid disease.

Methods: Retrospective review of patients under 18 years of age with the diagnosis of TN submitted to fine needle aspiration biopsy (FNAB) from 2010 to 2016.

Results: Seventy-three patients [21% males; mean age 13.8(3.2) years] were included. 46.6% had palpable nodules. 84.9% were euthyroid and 12.3% had hypothyroidism. 31.5% of the patients had positive anti-thyroid antibodies. Ultrasound showed that TN had a diameter range of 15.9±9.8 mm, 47.9% patients had a solitary nodule, 31.5% TN were hypoechoic, 5.5% had increased intranodular flow, 10.9% had microcalcifications and 5.5% had irregular margins. We found that 5.5% of patients had undergone previous cervical irradiation and 12.3% had FHDTC. 84.9% of the patients had a conclusive FNAB at first: benign in 39 (colloid (n=25), chronic lymphocytic thyroiditis (n=12), granulomatous thyroiditis (n=1), thymus tissue (n=1)), FLUS in 4, suspected follicular neoplasia in 3, suspected malignancy in 1 and papilar carcinoma in 15 patients. Thyroidectomy was performed in 43.8% of the patients. In histology, 71.9% were diagnosed as malignant. One patient developed permanent hypoparathyroidism after surgery. We verified that the FHDTC was more frequently present in the malignant nodules (26% vs 6%, P=0.024), while for the other factors mentioned above there were no statistically significant differences.

Conclusion: In most patients a conclusive diagnosis was achieved with FNAB. The high prevalence of malignancy was similar to that described in the literature. FHDTC was the only factor found associated with an increased risk of malignancy.