ESPE2024 Poster Category 1 Thyroid 1 (9 abstracts)
Thyroid nodules in children and adolescents: 26 years of experience in a large single academic center
Maxime Gest-Laurent 1 , Adrien Nguyen-Quoc 2 , Christine Lefevre 3 , Laura Gonzalez-Briceno 4 , Caroline Thalassinos 5 , Isabelle Flechtner 5 , Maria-Beatriz Arrom-Branas 5 , Graziella Pinto 5 , Dinane Samara-Boustani 5 , Dulanjalee Kariyawasam 5,6 , Hervé Monpeyssen 7 , Sabine Sarnacki 8,6 , Vincent Couloigner 9,6 , Michel Polak 5,10,6 & Athanasia Stoupa 5,10
1Centre Hospitalier Universitaire de Clermont-Ferrand, Pédiatrie, Clermont-Ferrand, France. 2Cochin Institute, U1016, Paris, France. 3CHU de Lille, Endocrinologie Pédiatrique, Lille, France. 4Centre Hospitalier de Sens, Sens, France. 5Hôpital Universitaire Necker Enfants Malades, Service d'Endocrinologie, Diabétologie et Gynécologie Pédiatriques, Paris, France. 6Université Paris Cité, Faculté de Médecine, Paris, France. 7Institut de la Thyroide, Paris, France. 8Hôpital Universitaire Necker Enfants Malades, chirurgie pédiatrique viscérale et urologique, Paris, France. 9Hôpital Universitaire Necker Enfants Malades, ORL pédiatrique, Paris, France. 10Centre Régional de Dépistage Néonatal, Ile-de-France, Paris, France
Introduction: Thyroid nodular disease in paediatric age has a lower prevalence but higher rate of malignancy compared to adults. The most frequent risk factors for thyroid cancer are young age, family history, underlying thyroid disease, previous malignancy, genetic predisposition and radiation exposure.
Objectives: Describe the demographics, nodules’ etiology and malignancy characteristics and compare the diagnostic approach and management of children with thyroid nodules with current guidelines.
Material and Methods: We conducted a retrospective observational study of patients aged 0-18 years at diagnosis in 1997-2023 period for thyroid nodules greater than 0.5 cm, followed up at the Paediatric Endocrinology, Diabetology and Gynecology Department in Necker Children’s University Hospital, Paris.
Results: Data from 198 patients have been initially collected, we finally studied 159 patients after exclusion of 39 patients with incomplete data and/or lost during follow-up. Majority of patients are female (n = 118, 74%) and mean age at diagnosis is 11.9 years (interquartile range, IQR: 9.9-14.1). Autoimmune thyroid disease is present at 47(27%) patients at diagnosis, concerning equally hypothyroidism (n = 24) or hyperthyroidism/Graves’ disease (n = 23). Mean major nodule diameter (mm) is 18.5 mm (IQR: 8-29). The overall rate of malignancy is 16.4% (26/159 nodules). Radiation exposure history is present for 11 patients, with significant difference between benign and malignant nodules (P = 0.006). No difference in 2 groups has been noted in nodule size and background of thyroiditis (P = 0.12 and P = 0.14, respectively). Multiple nodules are observed in almost half of patients (n = 83, 52.3%), most of them with benign features. Initial assessment of thyroid nodules (thyroid function tests and ultrasound) is consistent with current recommendations in 156/159 patients. Thyroid ultrasounds describe the necessary elements to calculate the TIRADS score in few cases. Fine Needle Aspiration Biopsy (FNAB) has been performed in 83 (52%) of cases; being non contributive or with undetermined cytology in 29 cases. Thirteen nodules are autonomous, treated by surgery in 11 cases. Familial history and clinical examination features oriented molecular testing for inherited tumor syndrome. Pathogenic variants have been identified in DICER1, PTEN (PTEN hamartoma tumor syndrome), RET (multiple endocrine neoplasia type A), and XPC (xeroderma pigmentosum) genes.
Conclusion: This study highlights the importance of the medical history, clinical examination and ultrasound by an experienced radiologist. FNAB is useful for differentiating benign and malignant nodules and should be repeated in case of non-contributive results. Long-term follow-up is crucial for definite diagnosis and improvement of cancer detection rate.
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