Report of one case of malignancy among 17 autonomous thyroid nodules in children and adolescents

Abstract

Aim This study aimed to report a case of malignancy in a series of 17 autonomous thyroid nodules in children/adolescents. Methods We performed a retrospective analysis of patients with thyroid nodules between 2003 and 2018 who had the following characteristics: (i) low serum thyroid stimulating hormone (TSH); (ii) nodule(s) > 1 cm on ultrasonography; (iii) homogenous uptake on scintigraphy with radioiodine in the area corresponding to the nodule(s); (iv) suppression of the remaining parenchyma; and (v) age ≤ 18 years. The approach of the institution was to perform fine‐needle aspiration in all children/adolescents with autonomous thyroid nodules, as well as surgery in all patients of this age group with toxic nodular disease. Results Thirteen patients, 11 girls and 2 boys aged 9–18 years, had 17 autonomous nodules ranging in size from 1.4 to 5.5 cm. Cytology was benign in 11 nodules (64.7%) and histology confirmed the benign nature in all of them. Two nodules (11.7%) had non‐diagnostic cytology and were also benign. Cytology was indeterminate in three other nodules (17.6%), with two adenomas and one follicular tumour of uncertain malignant potential. Finally, cytology was suspicious for malignancy in only one nodule (5.9%) for which the infiltrative follicular variant of papillary thyroid carcinoma was confirmed. The patient was a 13‐year‐old girl whose nodule exhibited highly suspicious ultrasonography features. Conclusion The incidence of malignancy in this series of 17 autonomous thyroid nodules in children/adolescents was 5.9%.

Comment on: Report of One Case of Malignancy Among 17 Autonomous Thyroid Nodules in Children and Adolescents

“…In conclusion, adopting USbased criteria for malignancy risk assessment of ATNs could be helpful for decision-making in paediatric patients with ATNs, but further evidence is needed. Although the data reported by Rosario et al 1 are encouraging, we suggest a note of caution until data from larger multicentre series are available.…”

“…Frey syndrome (auriculotemporal nerve dysfunction with gustatory flushing) is rare in the paediatric population and typically associated with instrumental delivery. 1 It is more common in adults after parotid gland surgery. In infants, it is likely caused by injury to the auriculotemporal nerve and subsequent cross innervation with parasympathetic and sympathetic nerve fibres.…”

“…2,5,6 Departments of1 Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, 3 Clinical and Experimental Medicine, University of Messina 4 Endocrine Unit, "G. Martino" University Hospital, Messina, Italy 2 Thyroid Committee, European Association of Nuclear Medicine, Vienna, Austria 5 Clinic for Nuclear Medicine and Competence Centre for Thyroid Diseases, Imaging Institute of Southern Switzerland, EOC, Bellinzona and 6 Clinic for Nuclear Medicine, University Hospital and University…”

“…We read with interest the paper by Rosario et al who retrospectively evaluated a series of 17 autonomous thyroid nodules (ATNs) diagnosed in 13 patients aged 9-18 years 1. All were affected by hyperthyroidism due to thyroid nodule(s) >1 cm in greatest diameter, homogenously 'hot' at thyroid scintigraphy while the remaining thyroid parenchyma was suppressed.…”

Autonomously functioning thyroid nodule due to a somatic TSHR mutation

“…The American Thyroid Association recommends surgical resection as the initial approach in children, although, because of its low malignancy in adults, there are other treatment options for AFTN in adults, including radioactive iodine, ethanol injection, or long‐term antithyroid drugs. The incidence of malignancy in pediatric AFTN is reported to vary from 0% to 29% 5 ; however, considering the risk of malignancy in children, surgical resection would be preferable to other treatment option. Radioactive iodine therapy for children under 18 years of age in Japan is under careful consideration if other treatment options are not possible.…”