Background: Hashimotos thyroiditis (HT) has been linked to papillary cancer in adults but not in children and adolescents. Moreover, there is no agreement on the more appropriate frequency of thyroid ultrasound (TS) in the follow-up of children with HT.
Objective and hypotheses: The aim of the study was to investigate the incidence of thyroid nodules and of thyroid cancer in a large group of children and adolescents (567) with HT followed-up for a mean period of 4.6 years (1.211.8 years).
Method: At each visit the auxological data were recorded, TSH, fT4, TPO- and TG-antibodies were measured and a TS was performed to assess the thyroid volume, detect nodules > 0.5 mm and to classify the echographic changes (score 15). The presence of lymphoadenopathy or palpable nodules, treatment with L-thyroxine, results of eventual fine needle biopsy (FNB) were also recorded. 567 patients (440 females and 127 males, mean chronological age at diagnosis 10.7±3.0 years) participated to the study. Median period of follow-up was for 4.6 years (1.211.8 years).
Results: At the time of diagnosis, TSH was 16.0±69.1 μIU/ml (range 01000; nv 0.33.69), fT4 9.2±6.4 pg/ml (range 0.4667.4; nv 917.7). At ultrasound, 35 patients (6.17%) showed nodules with a diameter >5 mm, and 145 patients had a thyroid volume greater than +2 S.D. 17 FNB were performed based on TS findings. The incidence of nodules was 3.5% per year and only a thyroid score more than 2 (severe parcelled hypoechogenicity) was predictive for the appearance of new nodules. Papillary cancer was found in one girl who did not show lymphoadenopathy.
Conclusion: Thyroid nodules are relatively frequent in HT children, particularly in those showing the most hypoechogenic pattern at ultrasonography. However, papillary cancer seems to be a rare condition in this age group.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology