ESPE Abstracts (2014) 82 P-D-2-1-593


Incidence of Thyroid Nodules in Children Affected by Hashimoto’s Thyroiditis: a 12-Year Survey of 567 Children

Silvia Longhia, Tommaso Aversac, Milva Bald, Antonella Cantasanod, Marco Cappae, Alessandra Cassiod, Andrea Corriasf, Valeria D’Antonioa, Filippo De Lucac, Raffaella Di Maseg, Roberto Gastaldih, Chiara Guzzettib, Sandro Locheb, Mariacarolina Salernog, Giulia Maria Tronconii, Maria Cristina Vigonei, Giovanna Weberi & Giorgio Radettia


aDepartment of Paediatrics, Regional Hospital of Bolzano, Bolzano, Italy; bPaediatric Endocrinology Unit, Microcitemico Hospital, ASL Cagliari, Cagliari, Italy; cDepartment of Paediatrics, University of Messina, Messina, Italy; dDepartment of Paediatrics, S. Orsola Malpighi Hospital, Bologna, Bologna, Italy; eUnit of Endocrinology and Diabetes, Bambin Gesù Children’s Hospital, IRCCS Roma, Roma, Italy; fDepartment of Paediatric Endocrinology, Regina Margherita Children Hospital, Torino, Torino, Italy; gDepartment of Paediatrics, University of Naples Federico II, Napoli, Italy; hDepartment of Paediatrics, Institute G. Gaslini, University of Genova, Genova, Italy; iDepartment of Paediatrics, Institute San Raffaele, Milano, Milano, Italy

Background: Hashimoto’s 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 (1.2–11.8 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 1–5). 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 (1.2–11.8 years).

Results: At the time of diagnosis, TSH was 16.0±69.1 μIU/ml (range 0–1000; nv 0.3–3.69), fT4 9.2±6.4 pg/ml (range 0.46–67.4; nv 9–17.7). 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.