TY  - JOUR
T1  - DIagnostic features of thyroid nodules in pediatrics
AU  - Corrias A, Mussa A, Baronio F, et al
Y1  - 2010/08/01
N1  - 10.1001/archpediatrics.2010.114
JO  - Archives of Pediatrics & Adolescent Medicine
SP  - 714
EP  - 719
VL  - 164
IS  - 8
N2  - Objective 
    To investigate a cohort of pediatric patients with thyroid nodules, defining histotype frequency and differences between subjects with hyperthyroidism and euthyroidism and benign and malignant nodules.Design 
    Retrospective cohort.Setting 
    Consecutive cases from 9 Italian pediatric endocrinology centers for the last 10 years.Patients 
    One hundred twenty pediatric patients with thyroid nodules.Intervention 
    Doppler ultrasonography was performed in 71 subjects; scintiscan, in 56; fine-needle aspiration biopsy in 104; and 63 underwent surgery.Main Outcome Measures 
    The differences in clinical, laboratory, and ultrasonographic data between patients with hyperthyroidism and euthyroidism and malignant and benign nodules were evaluated.Results 
    One hundred fourteen patients had euthyroidism and 6, hyperthyroidism. The latter had more compressive signs (P = .003), greater nodule diameter (P = .02), intranodular vascularization pattern (P = .01), and increased scintiscan uptake (P < .001). Fine-needle aspiration biopsy disclosed benign lesions in 77 cases, malignant lesions in 19, and “suspicious” lesions in 8. Histologic examination disclosed 1 Hurthle cell and 5 follicular adenomas in patients with hyperthyroidism, whereas in patients with euthyroidism, 33 hyperplasic nodules, 19 carcinomas (14 papillary, 3 follicular, and 2 medullary), 3 follicular and 1 Hurthle cell adenoma, and 1 teratoma were detected. Nine patients had enhanced scintiscan uptake. Among the patients with euthyroidism, malignancies more frequently had palpable lymph nodes (P < .001), compressive signs (P = .004), microcalcifications (P < .001), intranodular vascularization (P = .01), and lymph node alterations (P < .001).Conclusions 
    The diagnosis of pediatric thyroid nodules should be based on a stepwise evaluation that includes clinical, laboratory, and radiographic modalities. While laboratory assessments establish thyroid function, ultrasonographic imaging identifies clinically unapparent nodules and provides detailed nodule characterization for suspected malignant lesions. Scintiscan in patients with hyperthyroidism and fine-needle aspiration biopsy in patients with euthyroidism represent the next logical step.
SN  - 1072-4710
M3  - doi: 10.1001/archpediatrics.2010.114
UR  - http://dx.doi.org/10.1001/archpediatrics.2010.114
ER  -