Endocrine Abstracts

JOINT1869

Background: Thyroid nodules in children are reported to be at 2-3-fold increased risk of being malignant when compared to thyroid nodules in adults. The risk for children of a thyroid nodule (>1 cm) being malignant is 20–25% compared to in 5–10% for a thyroid nodule in adults, respectively. Pediatric differentiated thyroid carcinoma (DTC) is a rare disease; however, its worldwide incidence is rising. The most common presentation for DTC in children is that of a thyroid nodule. Case report A 13-year-old adolescent girl was referred to our health insurance endocrine clinic for a clinically concerning thyroid swelling. She presented with 2-year history of a neck swelling. She had no complaints, no local compressive symptoms or dysphagia. There was no history of head or neck irradiation and no family history of thyroid cancer. She had normal vital signs with a BP of 110/70, pulse of 67. Her exam was significant for a diffusely enlarged thyroid gland with an irregular contour and a firm nodule 2x1.5 cm on the RT lobe. The rest for her physical exam was completely normal. TSH was 1.47 mcIU/ml, Ft4 was 1.28 ng/dl and she had positive anti-thyroid peroxidase: > 600 and Anti-thyroglobulin antibodies: 395. Our patient had an abnormal thyroid exam for as long as two years prior to being seen in our health insurance clinic. Unfortunately, she was not examined or investigated properly. Parents were reassured as there was no aggressive symptoms, her thyroid function tests within normal and positive thyroid antibody tests. Based on the clinical examination, ultrasound thyroid was requested, and the report showed: multinodular goiter with hypoechogenicity and solid nodules, largest one in the RT lobe is wider than taller solid hypoechoic nodule with irregular margin and measures about 28.7x24.5 mm (TR4 nodule pattern, moderately suspicious nodule pattern for FNAC) with few bilateral cervical lymphnodes. A fine-needle aspiration biopsy of the RT thyroid nodule was performed. The cytology diagnosis was: "papillary thyroid carcinoma". Accordingly was referred for surgical removal.

Conclusion: As palpable thyroid abnormalities have a higher risk of malignancy in children and the risk of surgical complications can be significant, so they should be closely monitored with suspicion and worked up aggressively for possible malignancy even in the face of initially negative diagnostic testing.