Endocrine Abstracts

Background: Toxic adenoma (TA) is a rare cause of hyperthyroidism in children, representing less than 3% of cases, more frequently affecting girls. The risk of malignancy in pediatric autonomous nodules is unknown. Despite current guidelines on the management of TA, published case series reveal discrepancies in medical practice.

Case presentation: We report a case of TA in a 7-year old boy, incidentally detected as a palpable mass during examination for laryngitis. Initial laboratory findings depicted TSH<0.005 μU/ml (0.4–4.14), fT4: 2.85 ng/dl (0.8–1.8) and negative thyroid autoantibodies, including Anti-TGs, Anti-TPOs and TRAbs. The child had no symptoms of hyperthyroidism. Thyroid ultrasound revealed a thyroid nodule of 3.26×2.5×1.8 cm, with no signs suggestive of malignancy. Treatment with carbimazole was initiated promptly. Scintigraphy with ⁹⁹Tc confirmed the diagnosis of TA, with increased focal uptake and peripheral suppression Surgical resection was scheduled and, in the meantime, propranolol was added to treatment due to tachycardia. Gradually euthyroidism was achieved. On surgeon’s request, the child received potassium iodine 4 days prior to surgery, as well as vitamin D and calcium. Histologic examination was negative for malignancy. Carbimazole, propranolol and calcium were discontinued on the 2^nd, 5^th and 10^th post-operative day, respectively. Treatment with thyroxine was initiated on the 6^th post-op day.

Conclusions: This is a rare case of TA in a prepubertal boy. Despite guidelines, highly experienced surgeons on such rare entities are not broadly available. More case reports are necessary in order to validate best management strategies.