Endocrine Abstracts (2011) 27 OC1.3

High likelihood of malignancy in patients presenting with a thyroid nodule

Furrukh Jamil & Tim Cheetham

The Great North Children’s Hospital, Newcastle upon Tyne, UK.

Introduction: Thyroid nodules in children are more often malignant than in adult practice (~26 vs 5–10%) and in our locality the incidence of thyroid cancer in young people is increasing. We therefore assessed the presentation, investigation, histology and management of paediatric patients presenting with thyroid nodules.

Methods: This was a retrospective audit conducted at a regional unit (catchment population ~3 million) where young people are likely to be referred. Data were collected for the preceding 15 years with subjects excluded if they were >18 years old, if they were positive for thyroid autoantibodies or if they had a family history of MEN/RET. Patients were identified through endocrine and multi-disciplinary team records and radiology data (neck ultrasound examinations). A nodule was defined as a mass on examination or ultrasound that was ≥1.0 cm in diameter.

Results: Twenty-nine patients were eligible for inclusion. Twenty-seven patients were euthyroid, while the biochemical status of two patients was unknown. All patients underwent a thyroid ultrasound scan except one who underwent neck exploration without imaging. Needle biopsy (n=25) disclosed benign lesions in 8 (32%) cases, malignant lesions in 4 (16%) and was inconclusive in 13 (52%) cases. Subsequent histological examination of nodular tissue (n=23) disclosed 11 (48%) malignant and 12 (52%) benign lesions. Malignant lesions included papillary and follicular carcinomas, while benign lesions included multinodular goitre and adenomas. Of patients presenting with a palpable thyroid nodule, 38% had malignant disease. No patient with more than one nodule clinically had malignant disease (P=0.014).

Conclusion: More than a third of children in our locality with a thyroid nodule and who are thyroid antibody negative will have malignant disease. These figures are greater than most in the literature and patients should be counselled and managed with these figures in mind.

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