Background: In a recent report we have identified multinodular goiter (MNG) as a condition with an increased risk for thyroid malignancy in children and adolescents.
Objective and hypotheses: To report the prevalence and characterization of a prospectively and uniformly followed cohort of pediatric patients with MNG and to retrospectively analyze differences between benign and malignant MNG before surgery in order to identify malignancy predictors.
Method: We studied 32/104 patients under 19 years of age referred to our center for thyroid nodules between 2008 and 2015, who presented MNG and reached a final diagnosis (benign vs. malignant) by surgery (n:24) or by at least 1 year (range:1.56.5) of clinical follow up (n:8). Initial evaluation included clinical data, thyroid function, Doppler-US and US-FNAB cytology categorized with the Bethesda System.
Results: Upon admission mean age was 13.6 years, 75% were females, 69% pubertal. Papillary thyroid carcinoma (PTC) was found in 8 patients (25%). Risk factors, present in 5/32, were not associated with malignancy. All patients with familiar MNG (n:6) had a benign diagnosis. Younger age (10.4 vs 14.8 years), prepubertal status (5/8 vs 5/24,) and pathologic lymphadenopathies (4/8 vs 1/24) were significantly associated with malignancy (P<0.05). All malignant nodules were solid (8/8 vs 12/24, P<0.05). Conversely, the finding of mixed/cystic nodules on US was always associated with a benign diagnosis (P<0.05). Although within the normal range, median TSH concentration was higher in patients with PTC (3.5 vs 1.4 mIU/l, P<0.05) and the likelihood of PTC increased with rising TSH levels. Malignancy risk in Bethesda categories I, II, III, V and VI was 0, 7.7, 0, 75 and 100% respectively. PPV and NPV for Bethesda V-VI FNAB results were 86 and 96% respectively.
Conclusion: MNG represented 31% of our thyroid nodule population. PTC incidence was 25%, similar to that reported in pediatric thyroid nodules. Younger age, prepubertal status, higher TSH concentrations, solid nodules and pathologic lymphadenopathies were significantly associated with malignancy. These findings should be considered when facing the therapeutic approach for these patients.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology