Evaluation and management of pediatric thyroid nodules and thyroid cancer at a single institution after adoption of the American Thyroid Association 2015 guidelines
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Leen Matalka
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AKM Fazlur Rahman
Abstract
Objectives
The study purpose is to correlate clinical findings with rates of differentiated thyroid cancer (DTC) in a cohort of children presenting with thyroid nodules at a single institution since the adoption of the 2015 American Thyroid Association (ATA) Guidelines Task Force on Pediatric Thyroid Cancer.
Methods
Clinical, radiographic, and cytopathologic findings were retrospectively analyzed in a pediatric cohort (≤19 years) identified with ICD-10 codes for thyroid nodules and thyroid cancer from January 2017 until May 2021.
Results
We analyzed 183 patients with thyroid nodules. The mean patient age was 14 years (interquartile range 11–16) with a female (79.2 %) and white Caucasian (78.1 %) predominance. The overall DTC in our pediatric patient cohort was 12.6 % (23 out of 183). Most of the malignant nodules measured from 1–4 cm (65.2 %) with TI-RADS score of ≥4 (69.6 %). Among the fine-needle aspiration results (n=49), the highest frequency of DTC was within the malignant category (16.33 %), followed by suspicious for malignancy (6.12 %), then atypia or follicular lesion of undetermined significance (8.16 %), and lastly follicular lesion or neoplasm and benign with 4.08 % and 2.04 % respectively. Of the forty-four thyroid nodules that underwent surgical intervention, pathology was remarkable for 19 papillary thyroid carcinoma (43.18 %) and 4 follicular thyroid carcinoma (9.09 %).
Conclusions
Based on the analysis of our pediatric cohort in the southeast region at a single institution, adoption of the 2015 ATA guidelines could lead to an increased accuracy in detecting DTC while reducing the number of patients requiring interventions, such as FNA biopsy and/or surgeries. Further, based on our small cohort, it would be reasonable for thyroid nodules 1 cm or less to be monitored clinically with physical exam and ultrasonography, with further therapeutic or diagnostic intervention considered based on concerning features or parental shared decision making.
Funding source: Kaul Pediatric Research Institute (KPRI), Children’s of Alabama, Birmingham, AL
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Research funding: Kaul Pediatric Research Institute (KPRI), Children’s of Alabama, Birmingham, AL.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interest: Authors state no conflict of interest.
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Informed consent: Informed consent waiver approved by the UAB IRB.
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Ethical approval: The University of Alabama at Birmingham (UAB) Institutional Review Board approved the study.
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© 2023 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Review Article
- Molecular mechanisms involved in fetal programming and disease origin in adulthood
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Artikel in diesem Heft
- Frontmatter
- Review Article
- Molecular mechanisms involved in fetal programming and disease origin in adulthood
- Original Articles
- Neuropathy in paediatric type 1 diabetes mellitus – clinical characterization and analysis of risk factors in the diabetes prospective follow-up registry DPV (Diabetes-Patienten-Verlaufsdokumentation)-registry
- Effect of metabolic control on cognitive functions in children and adolescents with type 1 diabetes mellitus
- Uric acid and sCD163 as biomarkers for metabolic dysfunction and MAFLD in children and adolescents with overweight and obesity
- Endocrinological, immunological and metabolic features of patients with Fabry disease under therapy
- Evaluation and management of pediatric thyroid nodules and thyroid cancer at a single institution after adoption of the American Thyroid Association 2015 guidelines
- Fasting ketone levels vary by age: implications for differentiating physiologic from pathologic ketotic hypoglycemia
- Association of adipocytokines and adipocytokine ratios with cardiovascular risk factors in Japanese preadolescents
- Daily vs. monthly oral vitamin D3 for treatment of symptomatic vitamin D deficiency in infants: a randomized controlled trial
- Short Communication
- Management and outcomes in secondary diabetes among pediatric patients hospitalized with hemophagocytic lymphohistiocytosis
- Letter to the Editor
- Potential usefulness of assessing serum betamethasone levels during betamethasone therapy
- Case Reports
- Acquired idiopathic isolated ACTH deficiency with associated autoimmune thyroiditis in pediatrics: case report and review of the literature
- A very rare cause of hypertrygliseridemia in infancy: a novel mutation in glycerol-3-phosphate dehydrogenase 1 (GPD1) gene
- Difficult to think about but easy to treat: scurvy
- Severe hypophosphataemia can be an early sign of osteopetrorickets: a case report
- Corrigendum
- Diagnosis of adrenal insufficiency in children: a survey among pediatric endocrinologists in North America
