ESPE Abstracts

Introduction: Although thyroid nodule is seen less frequently in childhood than in adults, it is more likely to be malignant. The aim of this study was to examine the characteristics of the patients followed up for thyroid nodules and to define the patients with malignant potential by laboratory, radiological and cytological evaluations.

Method: 100 patients (F/M:63/37) with thyroid nodules followed up in Pediatric Endocrinology Clinic between 2010-2021 were retrospectively reviewed. Clinical, laboratory, imaging findings, cytology and histological results of the operated patients were recorded.

Results: The mean age at diagnosis was 12.9 ± 4.1 years. In the ultrasonographic (USG) evaluation,70% of the patients had a single nodule. The size of the nodules was ≥1 cm in 44% of the patients.48% of the nodules were solid,58% of them were hypoechoic.19%(n=9) of 48 patients who underwent fine needle aspiration biopsy (FNAB) had inadequate/non-diagnostic cytology,37.5%(n=18) were benign,12.5%(n=6) atypia/undetermined significance (AUS/FLUS),29%(n=14) suspected/malignant.22 patients underwent surgical treatment; total thyroidectomy was performed in 77%(n=17), lymph node dissection was performed in 68%(n=15) of the patients. The most common papillary carcinoma (68%, n=15) was detected, while the histology of 3 patients was benign. The histology of 4/6 patients whose cytology was AUS/FLUS was found to be malignant (Papillary carcinoma). Due to the suspicion of malignancy in the follow-up of 4 patients whose cytology was benign, surgery was performed and the histology of 2 of them was found to be compatible with malignancy. Lenf node metastasis was detected in 66%(n:10/15) patients. Nodules of 17 patients with malignancy were found to be single in 82%(n=14),94%(n=16) ≥1 cm in size,76%(n=13) solid,58%(n=10) hypoechoic and 41%(n=7) of them had microcalcification. Age, gender, thyroid function tests, autoantibody positivity nodule size, number of nodules, increased blood supply were not found to be associated with malignancy, while the presence of microcalcification, solid structure and hypoechoic nodule were associated with malignancy (P<0.005).

Conclusion: Malignancy was detected in 17% of our patients followed up for thyroid nodules and 37% of those who underwent FNAB. Although the Bethesda classification of FNAB can be applied reliably in children, the malignancy rate was found to be higher in surgically removed nodules, especially in those with cytology of AUS/FLUS, compared to adults. In addition to the result of FNAB, it is important to make a careful evaluation in terms of malignancy in patient of sonographic findings such as microcalcification of the nodules, solid and hypoechoic structure.