The Turkish Journal of Pediatrics
2014 , Vol 56 , Num 3
Approach to Thyroid Nodules in Children and Adolescents
Pediatric Endocrinology Clinics, 1İpekyolu Hospital, Van, and 2Dr. Sami Ulus Obstetrics, Children Health and Diseases
Research and Training Hospital, Ankara, Turkey. E-mail: asanonder@yahoo.com
Thyroid nodule prevalence is about 1.8% in healthy children; however,
malignancy frequency is higher than in adults. Approximately 26.4% of
thyroid nodules generate thyroid cancer in childhood. Coexisting thyroid
disease, history of irradiation of the neck, post-pubertal age, female sex,
and thyroid malignancy in the family are risk factors for developing nodules.
After evaluation of the medical history and detailed physical examination, the
second step is assessment of thyroid function and measurement of calcitonin
level. Thyroid stimulating hormone (TSH) value in the upper range seems to
be correlated with cancer. Calcitonin levels must be evaluated, especially if
medullary cancer is suspected. Ultrasonography (USG) is the first-line imaging
tool in the diagnosis of thyroid nodules. It gives information about the nodule
size, echogenicity and location. Hypoechogenicity, microcalcifications, undefined
margins, high internodular vascular flow, and subcapsular localization are clues
of malignant lesions. Scintigraphy is only recommended in a solid nodule
with the presence of suppressed TSH. Fine-needle aspiration biopsy (FNAB)
has 90% accuracy and is very useful in the selection of patients for surgery.
It must be applied to all nodules ≥1 cm and nodules ≤1 cm suspicious for
malignancy. The other diagnostic tools are elastography, immunocytochemical
markers and genetic evaluation. In the management of thyroid nodules,
surgery is advised, especially if there is difficulty in distinguishing benign
lesions from carcinoma.
Keywords :
thyroid nodule, children, adolescents.