Pathogenesis, diagnosis and management of thyroid nodules in children

The aim of the present paper is to summarize the clinical management of thyroid nodules in children and to propose a work-up which is very likely to diagnose benign or malignant thyroid neoplasia, preoperatively

M Niedziela

2006

Scholarcy highlights

  • Thyroid nodules are uncommon in children before puberty
  • In our recent analysis of patients seen in the years 2001ÿ2004, i.e. a few years after the reintroduction of iodine in the diet in January 1997, we found a remarkably higher incidence of thyroid carcinoma in children with HT and with positive titers of TPO antibodies
  • In Poland, the transition period from iodine deficiency to adequacy resulted in the detection of an increase in solitary nodules and multinodular goiter
  • The iodine given as a prophylaxis may be responsible for the increase in autoimmune thyroid disease and may have provoked the development of papillary thyroid carcinoma, the only type of thyroid cancer detected to date in these patients
  • On the other hand, based on a review of the literature, children with Congenital hypothyroidism are at risk of developing follicular thyroid carcinoma, the absolutely predominant type of thyroid cancer found in children with dyshormonogenesis
  • An adequate diagnosis can be made in more than 90% of undifferentiated, medullary and papillary carcinomas using fine-needle aspiration biopsy
  • FTC observed in two patients with Hodgkin’s lymphoma may suggest a mechanism of cancer formation independent of radiation
  • The exclusion of pheochromocytoma in these patients is obligatory to avoid a life-threatening emergency during thyroidectomy

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