Background: In adults, autonomously functioning thyroid nodule (AFTN) rarely require cytologic evaluation and hyperthyroidism is often treated with radiojod (131J). In children and adolescents with AFTNs thyroid carcinoma was identified in about 10%.
Results: An 17-year-old adolescent presented with symptoms of hyperthyroidsm. She suffered from agitation and headache. Thyroid function tests revaled a suppressed TSH (0.10 mIU/ml (reference range 0.514.3)), fT3 elevated with 4.9 ng/l (reference range 2.34.2) and normal fT4 11.8 ng/l (reference range 8.917.6). Her height was 163 cm (−0.8 S.D.), her weight 64 kg, BMI 24.3 kg/m2 (+1.0 S.D.). Blood pressure was 125/76 and heart rate 80. She had a visible swelling of the left lobe of her thyroid with a palpable compact nodule. No lymph nodes were palpabel. Further clinical examination was without pathological findings. No change in her weight or bowel habits was noted. Her medical history was unremarkable, no history of radiation exposure. TSH-receptor-antibodies were negativ, Calzitonin was not elevated (1.58 ng/l (reference range 5.179.82)). Thyroglobulin was elevated with 725 μg/l (reference range: 3.577). The thyroid ultrasonography showed a large hypoechoic tumour with cystic transformation 3.6×2.3×1.7 cm in the left lobe. Treatment was started with carbimazole 10 mg/day. Hemithyroidectomy was perfomed and histopathologic analysis revealed a benign follicular adenoma, diameter 3.1 cm.
Conclusion: We describe an adolescent with a hyperfunctioning thyroid nodule due to a follicular adenoma. Hemithyroidectomy was performed because of the visible nodule and the nodule size. Presence of a palpable nodule and large nodule size are associated with an increased risk for malignancy. Detection of an AFTN in children and adolescents does not rule out the possibility of thyroid cancer. Surgery may serve as therapy and diagnostic tool.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology