Description
Thyroid nodules in children are less common than in adults but carry a higher risk of malignancy. Most nodules are benign, often linked to iodine deficiency, inflammation, or cysts. However, warning signs that warrant concern include rapid growth, firmness, hoarseness, difficulty swallowing, or swollen lymph nodes. A family history of thyroid cancer or exposure to radiation also increases risk. Evaluation involves ultrasound and, if necessary, fine-needle aspiration biopsy. Early diagnosis and management are crucial for effective treatment. Regular monitoring and consultation with a pediatric endocrinologist ensure timely intervention and improved outcomes for affected children.
Résumé
- Thyroid nodules in children, while rare, present a higher risk of malignancy compared to adults, making accurate identification crucial. Guidelines from the American Thyroid Association (ATA) and the European Thyroid Association (ETA) provide frameworks for evaluation and management, emphasizing the importance of personal and family history to identify potential hereditary syndromes associated with increased thyroid cancer risk.
- Initial evaluation involves a thorough physical exam, noting nodule size, consistency, and any associated symptoms like hoarseness or lymphadenopathy. Ultrasound is the gold standard for imaging, assessing nodule characteristics to determine the risk of malignancy. Key ultrasound features include margin definition, shape, presence of microcalcifications, echogenicity, and vascularity, leading to a Tyra staging to categorize suspicion level.
- The next step is TSH measurement; if suppressed, a scintigraphy helps determine if the nodule is autonomous. Fine needle aspiration (FNA) is crucial for suspicious nodules, allowing histopathological examination using the Bethesda system. Bethesda staging guides further management, ranging from surveillance for benign nodules to surgical intervention for suspicious or malignant ones.
- ATA guidelines advocate FNA for all solid/partly solid nodules >1 cm, or smaller ones with suspicious features. They highlight specific ultrasound findings (hypoechogenicity, irregular margins, hypervascularity, microcalcifications, lymph node abnormalities) as high-risk. Comprehensive cervical lymph node ultrasound is recommended, and FNA should be ultrasound-guided.
- Surgical options vary based on diagnosis. Benign nodules with compression or cosmetic concerns may warrant surgery. Autonomous nodules often require hemithyroidectomy for definitive diagnosis and treatment. Confirmed differentiated thyroid cancer necessitates total thyroidectomy and potentially lymph node dissection, guided by pre-operative and intra-operative findings.
- Post-operative management includes levothyroxine therapy, monitoring TSH and thyroglobulin levels. I-131 therapy may be indicated for persistent disease or distant metastasis. Though pediatric thyroid cancer often presents with advanced disease, the prognosis remains favorable, with high survival rates due to the well-differentiated nature and responsiveness to radioactive iodine.
- A multidisciplinary approach involving radiologists, pathologists, surgeons, and endocrinologists is essential for optimal care. FNA is a key diagnostic tool, enabling risk stratification and appropriate management decisions. While benign nodules are common, the goal is to exclude malignancy, minimize overtreatment, and effectively treat high-risk patients based on current guidelines and individualized assessment.
Exemple de certificat
À propos des intervenants
Dr Rahul Reddy
Consultant - Pediatric Endocrinology at Ankura Hospitals, Hyderabad
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