Co-Existence of Thyroid Nodule and Thyroid Cancer in Children and Adolescents with Hashimoto Thyroiditis: A Single-Center Study

Abstract

Background: Currently, there is an inadequate number of studies on nodule and malignancy development in children and adolescents with Hashimoto thyroiditis (HT). Material and Methods: Patients who were diagnosed with HT between 2004 and 2013 were included in the study. The HT diagnosis was made with a heterogeneous appearance on thyroid ultrasonography and the elevation of antithyroid peroxidase and/or anti-thyroglobulin antibodies. Fine-needle aspiration biopsy (FNAB) was performed in cases with a nodule size >1 cm or who had ultrasonography findings indicating malignancy. Results: A total of 39 (13%) thyroid nodules were detected in 300 patients with a diagnosis of HT. Papillary thyroid carcinoma (PTC) was diagnosed in 2 of the 12 cases in whom FNAB was performed. The thyroid nodule was detected at the same time as HT in the 2 cases with malignancy. The PTC diagnosis was made 2 years after the HT diagnosis in the first case and 3 years later in the second case. The largest diameter of the thyroid nodule was 5 mm in both cases. Conclusion: The thyroid nodule rate on an HT background was found to be 13%, and the thyroid malignancy rate was 0.67% in our study.

Ultrasound variants of autoimmune thyroiditis in children and adolescents and their clinical implication in relation to papillary thyroid carcinoma development

“…The analysis of US features seen on the thyroid scans revealed that the following five US variants of autoimmune thyroiditis were observed in our group of 179 paediatric patients: the most common in 35.2% diffuse thyroiditis with hypoechogenic background and normoechogenic parenchyma, in 30.2% diffuse thyroiditis with irregular background, in 18.9% nodular variant with normoechogenic irregular background, in 11.7% micronodulations, and in 3.9% diffuse hypoechogenic background. These ultrasound autoimmune thyroiditis features were already described in previous studies [ 9 , 17 – 20 ] but present classification is, to our knowledge, relatively novel in paediatric patients.…”

“…The association between Hashimoto’s thyroiditis and thyroid cancer has been debated and remains an active area of research and controversy [ 20 , 22 – 24 ]. If Hashimoto’s thyroiditis could be recognized as a precursor or a risk factor for thyroid cancer, this would have an obvious high clinical impact in paediatric population, given that Hashimoto’s thyroiditis is a rather common disease, with a rising incidence worldwide [ 22 ].…”

“…Keskin et al [ 20 ] analyzed 300 children with AIT and found the thyroid nodule rate on AIT ultrasound background to be 13%, and the thyroid malignancy rate 0.67%. Corrias et al [ 9 ] reported a thyroid nodule prevalence of approximately 31.5% in 365 pediatric AIT patients; thyroid cancer was present in at least 3% of the patients and in 9.6% of a subset of patients with thyroid nodules.…”

Clinical analysis of Hashimoto thyroiditis coexistent with papillary thyroid cancer in 1392 patients

“…Thus, when considering whether HT is a risk factor for PTC, it is necessary to investigate the levels of TSH. TSH is known to have a trophic effect on follicular-cell thyroid cancer and those of follicular-cell origin 24 . Elevated TSH might potentially increase the risk of thyroid tumour because of TSH-induced proliferation of thyroid cells 25 .…”

Hashimoto's Disease and Thyroid Cancer in Children: Are They Associated?

“…However, for children and adolescents, the association between HT and thyroid cancer seems relatively common. The frequency of PTC in children and adolescents with HT was found variable from 0.67 to ~3% ( 31 – 33 ). In patients with PTC, the prevalence of coexisting HT varied from 6.3% to more than 40% of the cases.…”