The risk of malignancy in thyroid nodules correlates with the presence of ultrasonographic features. In adults, ultrasound risk-classification systems have been proposed to indicate the need for further invasive diagnosis. Furthermore, elastography has been shown to support differential diagnosis of thyroid nodules. The purpose of our study was to assess the application of the American Thyroid Association (ATA), British Thyroid Association (BTA) ultrasound risk-classification systems and strain elastography in the management of thyroid nodules in children and adolescents from one center. Seventeen nodules with Bethesda III, IV, V and VI were selected from 165 focal lesions in children. All patients underwent ultrasonography and elastography followed by fine needle aspiration biopsy. Ultrasonographic features according to the ATA and BTA stratification systems were assessed retrospectively. The strain ratio in the group of thyroid nodules diagnosed as malignant was significantly higher than in benign nodules (6.07 vs. 3.09, p = 0.036). According to the ATA guidelines, 100% of malignant nodules were classified as high suspicion and 73% of benign nodules were assessed as low suspicion. Using the BTA U-score classification, 80% of malignant nodules were classified as cancerous (U5) and 20% as suspicious for malignancy (U4). Among benign nodules, 82% were classified as indeterminate or equivocal (U3) and 9% as benign (U2). Our results suggest that application of the ATA or BTA stratification system and elastography may be a suitable method for assessing the level of suspected malignancy in thyroid nodules in children and help make a clinical decision about the need for further invasive diagnosis of thyroid nodules in children.
Słowa kluczowe: zaburzenia różnicowania płciowego, zespół częściowej niewrażliwości na androgeny, gonadektomia, korekcja chirurgiczna narządów płciowych, substytucja hormonalna Key words: disorders of sex development, partial androgen insensitivity syndrome, gonadectomy, surgical correction of external genitalia, hormonal substitution Praca finansowana z grantu MNiSW nr N N407 277339 STRESZCZENIE/ABSTRACTZespół niewrażliwości na androgeny (AIS, androgen insensitivity syndrome, zespół Morrisa) jest wrodzonym, dziedziczonym w sposób recesywny sprzężony z chromosomem X, zaburzeniem rozwoju płciowego. Przedstawiono przypadek 11-letniej dziewczynki, diagnozowanej z powodu przerostu łechtaczki. Stwierdzono żeńską identyfikację płciową, obecność jąder w kanałach pachwinowych, a w badaniu cytogenetycznym kariotyp 46,XY. Badania hormonalne i obrazowe potwierdziły rozpoznanie zespołu częściowej niewrażliwości na androgeny. Ze względu na podwyższone ryzyko nowotworu złośliwego jąder, a także możliwość postępu objawów wirylizacji chorą zakwalifikowano do zabiegu całkowitego usunięcia gonad. Odroczono chirurgiczną korekcję zewnętrznych narządów płciowych do okresu podojrzewaniowego. Rozpoczęto terapię estrogenową. Endokrynol. Ped. 13/2014;1(46):61-68.Androgen insensitivity syndrome (AIS, Morris syndrome) is a congenital, inherited in a recessive, X-linked manner disorder of sex development. A case of an 11-year-old girl diagnosed because of clitoromegaly is presented. Female gender identity, testes in inguinal canals and 46,XY karyotype in a cytogenetic analysis were recognized. Hormonal and imaging investigations confirmed the diagnosis of partial androgen insensitivity syndrome. Due to the increased risk of testicular malignancy and possibility of advancing virilisation the patient was qualified for a complete removal of the gonads. The surgical correction of the external genitalia was postponed until postpuberty. An estrogen replacement therapy was started.
Serum ferritin is one of the most widely used laboratory tests and is associated with both iron deficiency and iron overload. Currently, more and more attention is paid to the involvement of ferritin in processes other than iron metabolism. Low serum ferritin is unanimously associated with iron deficiency, while elevated serum ferritin may be a consequence of various medical conditions such as iron overload, an inflammatory process, SARS-CoV-2, organ failure, cancer, and endocrine disorders, including metabolic syndrome. We present a review of the literature on the role of ferritin in a variety of less obvious disease states in children.
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