Iranian Journal of Otorhinolaryngology

Iranian Journal of Otorhinolaryngology

Management of Thyroid Nodules in Children: A single-center experience

Document Type : Original

Authors
Malika El Omri
Oumaima Gabsi
Mouna Bellakhdhar
Monia Ghammem
Wassim Kermani
Mohamed Abdelkefi
Department of Ear, Nose, Throat and Head and Neck Surgery, Farhat Hached University Hospital, University of Sousse, Sousse, 4000, Tunisia.
10.22038/ijorl.2024.78964.3659
Abstract
Introduction:
Thyroid nodules are a common diagnosis in adults. However, in children, they are rare, occurring in only 1-5% of cases. Early diagnosis and prompt management are crucial due to the higher likelihood of malignancy. The aim of this study was to describe the characteristics of thyroid nodules in children and plan their therapeutic management.
Materials and Methods:
A retrospective study was conducted on 29 children who underwent surgery for thyroid nodules at our ENT department between 2000 and 2022.
Results:
The average age of the patients was 14.4 years, with a clear predominance of females (sex ratio of 0.16). The primary complaint was the appearance of an anterior cervical swelling in 82.7% of cases. The surgical procedures performed on the thyroid gland included isthmectomy in one patient, lobectomy in 16 patients, and total thyroidectomy in 12 patients. Total thyroidectomy was performed in one step in 10 cases and in two steps in 2 cases where papillary carcinoma was found in the final histological examination of the lobectomy parts.
Papillary carcinoma was confirmed in four cases (13.8%) after definitive histological examination. All patients had favourable outcomes. The mean follow-up was 31 months for benign cases and 15 months after the last course of radioactive iodine therapy for malignant cases.
Conclusion:
Thyroid nodules are uncommon in children. To evaluate the risk of malignancy in children with thyroid nodules, ultrasound and cytology should be performed. This will help determine the appropriate surgical management.
Keywords
Thyroid nodule
Pediatric
Thyroid cancer
Subjects
  1. ER Christison-Lagay, RM Baertschiger, C Dinauer, GL Francis, MM Malek, TB Lautz et al.  « Pediatric differentiated thyroid carcinoma: An update from the APSA Cancer Committee ». J  Pediatr Surg.2020;55(11): 2273‑83.
  2. Suh, H. S. Choi, A. Kwon, H. W. Chae, et H.-S. Kim.« Adolescents with thyroid nodules: retrospective analysis of factors predicting malignancy ». Eur J Pediatr.2020;179(2):317‑25.
  3. Francis GL, Waguespack SG, Bauer AJ, Angelos P, Benvenga S, Cerutti JM et al. « Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Pediatric Thyroid Cancer ». Thyroid. 2015; 25(7): 716‑59.
  4. Stack BC Jr, Twining C, Rastatter J, Angelos P, Baloch Z, Diercks G, et al.. « Consensus statement by the American Association of Clinical Endocrinology (AACE) and the American Head and Neck Society Endocrine Surgery Section (AHNS‐ES) on Pediatric Benign and Malignant Thyroid Surgery ». Head 2021;43(4):1027‑42.
  5. Lebbink CA, Links TP, Czarniecka A, Dias RP, Elisei R, Izatt L et al. «European Thyroid Association Guidelines for the management of pediatric thyroid nodules and differentiated thyroid carcinoma », Eur Thyroid J.2022;11(6): e220146.
  6. Quaglino F, Bellocchia AB, Tuli G, Munarin J, Matarazzo P, Cestino L et al. « Pediatric thyroid surgery: Retrospective analysis on the first 25 pediatric thyroidectomies performed in a reference center for adult thyroid diseases ».Front. Endocrinol.2023;14:1126436.
  7. Alkhars A, Abouzayd M, Rouf CE, Lardy H, Bakhos D, Pondaven-Letourmy S et al.. « Pediatric thyroid surgery: experience in 75 consecutive thyroidectomies », Eur Arch Otorhinolaryngol. 2019; 276(1):217‑22.
  8. Balice et G. Theintz. « Goitres et nodules thyroïdiens chez l’enfant et l’adolescent », Revue Médicale Suisse, 2007.
  9. Coutant, A. Lugat, É. Mirallié, I. Oliver-Petit, A. Stoupa, et D. Drui. « Consensus SFE-AFCE-SFMN 2022 sur la prise en charge des nodules thyroïdiens Chapitre 6 Nodules thyroïdiens de l’enfant ».2022.
  10. Jiang, R. O. Newbury, et R. S. Newfield. « Pediatric thyroid surgery and management of thyroid nodules – an institutional experience over a 10-year period », Int J Pediatr Endocrinol. 2016; 2016(1):1.
  11. Septer, V. Slowik, R. Morgan, H. Dai, et T. Attard. « Thyroid cancer complicating familial adenomatous polyposis: mutation spectrum of at-risk individuals ». Hered Cancer Clin Pract. 2013; 11(1):13.
  12. H. Won, J. Y. Lee, H. S. Hong, et S. H. Jeong. « Thyroid nodules and cancer in children and adolescents affected by hashimoto’s thyroiditis ». BJR.2018:20180014.
  13. Rago T, Di Coscio G, Ugolini C, Scutari M, Basolo F, Latrofa F et « Clinical features of thyroid autoimmunity are associated with thyroiditis on histology and are not predictive of malignancy in 570 patients with indeterminate nodules on cytology who had a thyroidectomy ». Clin Endocrinol. 2007; 67(3): 363‑9.
  14. Buryk MA, Simons JP, Picarsic J, Monaco SE, Ozolek JA, Joyce J et al.« Can Malignant Thyroid Nodules Be Distinguished from Benign Thyroid Nodules in Children and Adolescents by Clinical Characteristics? A Review of 89 Pediatric Patients with Thyroid Nodules ». Thyroid. 2015; 25(4): 392‑400.
  15. Tucker MA, Jones PH, Boice JD Jr, Robison LL, Stone BJ, Stovall M et al. Therapeutic radiation at a young age is linked to secondary thyroid cancer. The Late Effects Study Group. Cancer Res. 1991; 51(11):2885-8. 
  16. Sinnott, E. Ron, et A. B. Schneider. « Exposing the Thyroid to Radiation: A Review of Its Current Extent, Risks, and Implications », Endocr Rev. 2010; 31(5): 756‑73.
  17. T. Guille, A. Opoku-Boateng, S. L. Thibeault, et H. Chen. « Evaluation and Management of the Pediatric Thyroid Nodule ». Oncologist. 2015; 20(1):19‑27.
  18. K. Chiu, S. Sanda, P. Y. Fechner, et C. Pihoker.« Correlation of TSH with the risk of paediatric thyroid carcinoma ». Clin Endocrinol. 2012;77(2):316‑22.
  19. Richman DM, Benson CB, Doubilet PM, Peters HE, Huang SA, Asch E et al. « Thyroid Nodules in Pediatric Patients: Sonographic Characteristics and Likelihood of Cancer ». Radiology. 2018; 288(2): 591‑9.
  20. Koltin D, O'Gorman CS, Murphy A, Ngan B, Daneman A, Navarro OM et « Pediatric thyroid nodules: ultrasonographic characteristics and inter-observer variability in prediction of malignancy ». J Pediatr Endocrinol Metab.2016;29(7):789-94.
  21. Ogle, A. Merz, R. Parina, M. Alsayed, et M. Milas, « Ultrasound and the Evaluation of Pediatric Thyroid Malignancy: Current Recommendations for Diagnosis and Follow‐up ». JUM. 2018; 37(10): 2311‑24.
  22. M. Chan, J. Young, J. Prager, et S. Travers. « Pediatric Thyroid Cancer ». Adv Pediatr. 2017; 64(1):171‑90.
  23. Heider, S. Arnold, et X. Jing. « Bethesda System for Reporting Thyroid Cytopathology in Pediatric Thyroid Nodules: Experience of a Tertiary Care Referral Center ». Arch Pathol Lab Med.2020:144(4):473‑7.
  24. Cherella CE, Angell TE, Richman DM, Frates MC, Benson CB, Moore FD et al. « Differences in Thyroid Nodule Cytology and Malignancy Risk Between Children and Adults ». Thyroid. 2019; 29(8):1097‑104.
  25. D. Hay, T. Gonzalez‐Losada, M. S. Reinalda, J. A. Honetschlager, M. L. Richards, et G. B. Thompson. « Long‐Term Outcome in 215 Children and Adolescents with Papillary Thyroid Cancer Treated During 1940 Through 2008 ». World j. surg.2010;34(6): 1192‑202.
  26. A. Paulson, E. R. Rudzinski, et D. S. Hawkins. « Thyroid Cancer in the Pediatric Population ». Genes.2019;10(9):723.
  27. Josefson et D. Zimmerman. « Thyroid nodules and cancers in children. ». Pediatr endocrinol rev. 2008; 6(1):14‑23.
  28. Wang H, Mehrad M, Ely KA, Liang J, Solórzano CC, Neblett W et al. « Incidence and malignancy rates of indeterminate pediatric thyroid nodules », Cancer Cytopathol.2019;127(4):231‑9.
  29. Dzodic R, Buta M, Markovic I, Gavrilovic D, Matovic M, Djurisic I et al.« Surgical management of well-differentiated thyroid carcinoma in children and adolescents: 33 years of experience of a single institution in Serbia », Endocr J. 2014; 61(11): 1079‑86.
  30. Jarzab B, Handkiewicz Junak D, Włoch J, Kalemba B, Roskosz J et al..« Multivariate analysis of prognostic factors for differentiated thyroid carcinoma in children ». Eur J Nucl Med. 2000; 27(7):833‑41.
  31. Enomoto, Y. Enomoto, S. Uchino, H. Yamashita, et S. Noguchi. « Follicular thyroid cancer in children and adolescents: clinicopathologic features, long-term survival, and risk factors for recurrence », Endocr J.2013; 60(5): 629‑35.
  32. Akkari M, Schmitt D, Jeandel C, Raingeard I, Blanchet C, Cartier C et al. « Nodular recurrence and hypothyroidism following partial thyroidectomy for benign nodular thyroid disease in children and adolescents », Int J Pediatr Otorhinol. 2014; 78(10):1742‑6.
  33. J. Bauer. « Papillary and Follicular Thyroid Cancer in children and adolescents: Current approach and future directions ». Semin Pediatr Surg. 2020; 29(3): 150920.
  34. Adly MH, Sobhy M, Rezk MA, Ishak M, Afifi MA, Shafie AE et al.« Risk of second malignancies among survivors of pediatric thyroid cancer », Int J Clin Oncol.2018;23(4):625‑33.
Iranian Journal of Otorhinolaryngology
Volume 37, Issue 2
March and April 2025
Pages 65-71