Autonomously Functioning Thyroid Nodules In Patients <21 Years Of Age: The Rhode Island Hospital Experience From 2003€“2013 |
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| Institution: | 1. From the Department of Pediatrics, Division of Endocrinology and Metabolism, Providence, Rhode Island.;2. Department of Information Services, Lifespan Corporation, Rhode Island Hospital and Hasbro Children''s Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.;1. From the Division of Pediatric Endocrinology, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Ein-Kerem, Jerusalem, Israel;2. Hebrew University Hadassah School of Medicine, Ein-kerem, Jerusalem, Israel;3. Pediatric Specialist Clinic, Clalit Health Services, Jerusalem, Israel;4. Department of Pediatrics, Shaare-Zedek Medical Center, Bayit-Vegan, Jerusalem, Israel.;1. From the Unit of Endocrinology, Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Rome, Italy;2. Department of Medicine, Division of Endocrinology, Metabolism and Diabetes, Johns Hopkins University School of Medicine, Baltimore, Maryland.;1. From Vanderbilt University Medical Center, Division of Diabetes, Endocrinology and Metabolism, Nashville, Tennessee;2. University of Michigan, Division of Metabolism, Endocrinology and Diabetes, Ann Arbor, Michigan;3. Mayo Clinic, Division of Endocrinology, Metabolism, Nutrition & Diabetes, Rochester, Minnesota. |
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| Abstract: | Objective: This study evaluates the clinical characteristics, workup, treatment, and outcomes of pediatric patients diagnosed with an autonomously functioning thyroid nodule (AFTN) in a large cohort of patients presenting for evaluation of a thyroid nodule. There are few prior studies on AFTN in pediatrics, with limited data on treatment and outcomes. Rates of malignancy in AFTN are perceived as low, but prior studies have varying reports.Methods: This is a retrospective chart review of patients less than 21 years of age at Rhode Island Hospital over an 11-year period (2003–2013). We reviewed 354 charts, which yielded 242 patients with a diagnosis of thyroid nodule and 17 patients with AFTN.Results: The prevalence of AFTN in patients presenting with thyroid nodules was 7%. Mean age of patients was 15.8 years at diagnosis, and mean nodule size was 3.3 cm. There was female predominance. Thyroid-stimulating hormone levels were suppressed at diagnosis in 87% of patients. Six patients were treated with surgery, 5 patients with radioactive iodine therapy (RAI), 2 patients with medication, and 1 patient was observed without treatment. Three patients treated with RAI required subsequent treatment for hypothyroidism or continued hyperthyroidism. One patient had papillary thyroid carcinoma based on final surgical pathology.Conclusion: Our study found a higher prevalence of AFTN compared to the reported prevalence in adults. We concur with the new guidelines on management of thyroid nodules in recommending surgery for treatment of AFTN, based on the variability of outcomes after treatment with RAI.Abbreviations:AFTN = autonomously functioning thyroid noduleanti-TG = thyroglobulin antibodiesanti-TPO = thyroid peroxidase antibodiesFNA = fine-needle aspirationICD-9 = International Classification of Diseases, Ninth RevisionPTC = papillary thyroid carcinomaRAI = radioactive iodineT3 = triiodothyronineT4 = thyroxineTSH = thyroid-stimulating hormoneTSI = thyroid-stimulating immunoglobulin |
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