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- Jennifer N. Osipoff, MD*
- Thomas A. Wilson, MD*
- *Division of Pediatric Endocrinology, Department of Pediatrics, Stony Brook Children's Hospital, State University of New York, Stony Brook, NY.
Author Disclosure
Drs Osipoff and Wilson have disclosed no financial relationships relevant to this article. This commentary does contain a discussion of an unapproved/investigative use of a commercial product/device.
- FNAB:
- fine-needle aspiration biopsy
- I-131:
- a radioactive isotope of iodine
- MTC:
- medullary thyroid carcinoma
- PTC:
- papillary thyroid carcinoma
- rh-thyrotropin:
- recombinant human thyrotropin
- WDTC:
- well-differentiated thyroid carcinoma
- WBS:
- whole-body scan
Educational Gap
Although most pediatric thyroid masses are benign, some are malignant; thus, pediatricians must be able to assess for risk of malignancy and order appropriate diagnostic tests in conjunction with consultation with an endocrinologist.
Objectives
Develop a differential diagnosis and initial evaluation plan for a child or adolescent presenting with a thyroid mass.
List the risk factors associated with malignant thyroid nodules.
Understand the limitations of ultrasonography and fine-needle aspiration biopsy in the assessment of a thyroid nodule.
Recognize the risk factors inherent in surgical thyroidectomy.
Appreciate the current controversies in the management of pediatric thyroid nodules.
Introduction
Whether as part of a well-child examination, or in response to a patient or parent concern, it is important for the pediatrician to feel comfortable examining the thyroid gland. Although most pediatric thyroid masses are benign (Table 1 and Fig 1), in the event that a lesion is discovered, the pediatrician should be able to assess risk factors for malignancy and order appropriate diagnostic tests while awaiting consultation from the pediatric endocrinologist.
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Benign Thyroid Masses
A. A patient with an ectopic thyroid gland (upper protuberance) before treatment. B. The same patient a few months after starting levothyroxine. Note how the gland has shrunk in response to treatment.
Epidemiology
Palpable thyroid nodules in the pediatric and adolescent population are relatively rare, having an estimated prevalence of 0.2% to 1.4%, which is 5 to 10 times less than in adults. (1) Despite their lower occurrence, studies estimate 9% to 50% (mean, 26.4%) of thyroid nodules in children and teenagers are cancerous, significantly higher than the estimated 10% to 14% of lesions in adults. (2) In fact, thyroid cancers are …
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