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Diagnosing Autonomous Thyroid Nodules With Ultrasonography in Children and Adolescents

By: Kelly M. Hennessey, PhD
Posted: Tuesday, February 16, 2021

The risk of malignancy in adults with confirmed autonomous thyroid nodules is considered to be low, and fine-needle aspiration is not warranted; yet in children and adolescents with such thyroid nodules, the role of fine-needle aspiration may be less clear. In a small retrospective study, conducted by Theara de Castro Nicolau, MD, of the Institute of Teaching and Research of Santa Casa de Belo Horizonte, Minas Gerais, Brazil, and colleague, fine-needle aspiration was not found to be warranted in such younger patients unless indicated by suspicious ultrasound findings. Their results were published in the Journal of Paediatrics and Child Health.

This analysis included 13 patients aged 18 or younger who presented with autonomous thyroid nodules between 2003 and 2018. All patients had low serum thyroid-stimulating hormone levels, nodule(s) bigger than 1 cm on ultrasound, homogenous uptake on scintigraphy with radioiodine in the area corresponding to the nodule(s), and suppression of remaining autonomous nodules. Ultrasonography showed 12 nodules with a very low or low suspicious appearance, 4 nodules with an intermediate suspicious appearance, and 1 nodule was highly suspicious. Samples were obtained from all nodules using fine-needle aspiration, and all patients underwent surgery.

Histology and cytology results showed that 11 nodules were benign, 2 nodules were benign with nondiagnostic cytology, 3 nodules had indeterminate cytology, and 1 nodule was suspicious for malignancy. All 12 patients presenting with benign nodules were followed for 1 to 15 years (median, 7 years). No carcinomas or metastases were detected in any of the patients during that time.

“Our results suggest that the frequency of thyroid cancer in autonomous nodules is low in children/adolescents and that subjecting all of them to thyroidectomy because of this concern may be excessive,” explained the researchers. “Fine-needle aspiration would only be necessary in the case of suspicious ultrasonic findings,” they concluded.

Disclosure: The study authors reported no conflicts of interest.

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