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Goitre and thyroid nodules in children and adolescents.
Rev Med Suisse.
2007 Apr 18;3(107):981-5.
Systematic
examination of the thyroid gland allows discovering diffuse or
multinodular goitres as well as solitary nodules. Goitre may be the
only clinical manifestation of an underlying thyroid disease. Its
evaluation should consider the familial history as well as nutritional
and environmental factors. Thyroid ultrasonography is of critical
importance to assess the diagnosis. Hashimoto's thyroiditis, colloid
and endemic goitre are the most frequent causes of the diffuse form,
particularly during puberty. Multinodular goitre and solitary thyroid
nodule are rare in the paediatric age group: both conditions can
reveal a malignant lesion. In this case, a total thyroidectomy should
be performed. Long term outcome is excellent with an exception for
medullary carcinoma which can be part of a multiple endocrine
neoplasia (MEN type 2 A).
Thyroid
imaging in children.Endocr
Dev. 2007;10:43-61.
Ultrasonography
(US) and radionuclide thyroid scanning are the imaging modalities of
choice in the evaluation of the thyroid gland in children. The main
normal US patterns of the thyroid gland are reviewed. In early
infancy, thyroid imaging is usually performed in the context of
congenital hypothyroidism (CH). The aetiological diagnosis of CH is
usually based on the combined use of US and radionuclide thyroid
scanning. A detailed description of thyroid abnormalities observed in
CH is given. Thyroid dysgenesis includes athyreosis, 'empty' thyroid
area with ectopic thyroid tissue and thyroid hypoplasia (global
hypoplasia and thyroid hemiagenesis). Mild thyroid developmental
anomalies (pyramidal lobe, thyroglossal duct cysts, thyroid
hemiagenesis) may be observed in euthyroid patients or among
first-degree relatives of a CH population with thyroid dysgenesis. A
normally located gland (goitre, normal-sized thyroid gland or
hypoplastic thyroid gland) may also be observed in patients with CH.
The main patterns observed in chronic and acute thyroiditis, in
hyperthyroidism and thyroid tumours are described. Moreover, fetuses
and neonates born to mothers with Graves' disease are at risk of
thyroid dysfunction and goitre due to hypothyroidism in relation to
excessive maternal treatment or to maternal hyperthyroidism which may
be observed with fetal US.
Thyroid disorders in childhood and adolescence.J
Indian Med Assoc. 2006 Oct;104(10):580-2.
Thyroid disorders
are common endocrine problem encountered in the paediatric and
adolescent age group. Amongst the functional thyroid disorders
hypothyroidism is far more common than hyperthyroidism. Though simple
goitre is common in this age group, nodular goitre and in particular
solitary thyroid nodule are uncommon. Appropriate use of thyroid
function test can delineate practically all thyroid disorders.
Functional thyroid disorders lend themselves to effective treatment
and monitoring strategies. The basic management principles remain
similar to adults with thyroid dysfunction; experience in management
of paediatric and adolescent thyroid disorders is particularly
necessary to safeguard against long term detrimental effects of
under-or overtreatment as it can have repercussion on the growth of
the child. Prognosis in majority of the children tends to be good
provided that timely and appropriate management is undertaken.
Thyroid disorders in children from birth to adolescence. Eur
J Nucl Med Mol Imaging. 2002 Aug;29 Suppl 2:S439-46.
Thyroid hormones
play a crucial role as a regulator of growth, of nervous system
myelination, of metabolism, and of organ functions. Disorders
affecting the thyroid gland represent the most common endocrinopathies
in childhood. The etiology and clinical presentation of thyroid
disorders in children and adolescents substantially differ from that
in adults. Thus, pediatric medical care requires an appreciation of
distinct characteristics of thyroid function and dysfunction in
childhood and adolescence. Early diagnosis and treatment are essential
to prevent irreversible and permanent nervous system damage and
developmental delay, especially in infants as they are extremely
vulnerable to thyroid dysfunction. Therefore, as well as reviewing
distinct features of disorders with hypothyroidism, hyperthyroidism
and normal thyroid function in childhood and adolescence, this article
will also focus on important aspects of pre- and postnatal thyroid
development and physiology.
Foetal and neonatal thyroid disorders.Minerva
Pediatr. 2002;54(5):383-400.
Thyroid hormones
have been shown to be absolutely necessary for early brain
development. During pregnancy, both maternal and foetal thyroid
hormones contribute to foetal brain development and maternal supply
explains why most of the athyreotic newborns usually do not show any
signs of hypothyroidism at birth. Foetal and/or neonatal
hypothyroidism is a rare disorder. Its incidence, as indicated by
neonatal screening, is about 1:4000. Abnormal thyroid development
(i.e. agenesia, ectopic gland, hypoplasia) or inborn errors in thyroid
hormone biosynthesis are the most common causes of permanent
congenital hypothyroidism. Recent studies reported that mutations
involving Thyroid Transcriptor Factors (TTF) such as TTF-1, TTF-2,
PAX-8 play an important role in altered foetal thyroid development.
Deficiency of transcriptor factor (Pit-1, Prop-1, LHX-3) both in
mother and in the foetus represents another rare cause of foetal
hypothyroidism. At birth clinical picture may be not always so obvious
and typical signs appear only after several weeks but a delayed
diagnosis could have severe consequences consisting of delayed
physical and mental development. Even if substitutive therapy is
promptly started some learning difficulties might still arise
suggesting that intrauterine adequate levels of thyroid hormones are
absolutely necessary for a normal neurological development. Placental
transfer of maternal antithyroid antibodies inhibiting fetal thyroid
function can cause transient hypothyroidism at birth. If the mother
with thyroid autoimmune disease is also hypothyroid during pregnancy
and she doesn't receive substitutive therapy, a worse neurological
outcome may be expected for her foetus. Foetal and/or neonatal
hyperthyroidism is a rare condition and its incidence has been
estimated around 1:4000-40000, according to various authors. The most
common causes are maternal thyroid autoimmune disorders, such as
Graves' disease and Hashimoto's thyroiditis. Rarer non autoimmune
causes recently identified are represented by TSH receptor mutations
leading to constitutively activated TSH receptor. Infants born to
mothers with Graves' history may develop neonatal thyrotoxicosis.
Foetal/neonatal disease is due to transplacental thyrotrophin receptor
stimulating antibodies (TRAb) passage. It's extremely important
recognizing and treating Graves' disease in mothers as soon as
possible, because a thyrotoxic state may have adverse effects on the
outcome of pregnancy and both on the foetus and newborn. Thyrotoxic
foetuses may develop goitre, tachycardia, hydrops associated with
heart failure, growth retardation, craniosynostosis, increased foetal
motility and accelerated bone maturation. Neonatal Graves' disease
tends to resolve spontaneously within 3-12 weeks as maternal thyroid
stimulating immunoglobulins are cleared from the circulation but
subsequent development may be impaired by perceptual motor
difficulties. Hashimoto's thyroiditis is a very common autoimmune
thyroid disease. In presence of maternal Hashimoto's thyroiditis,
there are usually no consequences on foetal thyroid, even if antiTPO
and antiTg antibodies can be found in the newborn due to
transplacental passage. However there are some literature reports
describing foetal and neonatal hyperthyroidism in the affected
mothers' offspring.
The spectrum of thyroid diseases in childhood
and its evolution during transition to adulthood: natural history,
diagnosis, differential diagnosis and management.J
Endocrinol Invest.
2001 Oct;24(9):659-75.
In this
contribution, we review current knowledge on the pathogenesis,
diagnosis and differential diagnosis of thyroid disorders in childhood
and adolescence, as well as present an update on therapy methods and
management guidelines for these disorders. This overview is
conceptually divided into two parts, one focusing on thyroid
functional disorders, i.e. conditions leading to hyper- and
hypothyroidism, and another one pertinent to structural abnormalities
of the thyroid gland, i.e. nodular disorders and thyroid cancer.
Currently, congenital hypothyroidism is diagnosed in a much more
timely fashion rather than in the past, rendering
hypothyroidism-related mental retardation and developmental deficits
very rare in newborns and children and, hence, diminishing
significantly its public health impact. At the same time, considerable
advances have occurred in our understanding of the molecular basis of
several genetic conditions affecting the thyroid gland in childhood,
such as familial non-autoimmune hyperthyroidism, as well as of the
pathways leading to thyroid neoplasia.
Pediatric thyroid nodules: insights in management.
Bol Asoc Med P R.1998 Apr-Jun;90(4-6):74-8.
BACKGROUND:
Multiple diagnostic studies are utilized to unveil malignancy in
pediatric thyroid nodules and determine whether surgical therapy is
needed. PURPOSE: The aim of this report was to determine whether
management of pediatric thyroid nodules has changed with the current
use of diagnostic modalities such as ultrasonography (US),
radionuclear scans (RNS) and fine needle aspiration biopsy (FNAB).
MATERIAL/METHODS: Twenty-four children with thyroid nodules managed
during a ten-year period comprised the study group. Demographic
characteristics, clinical manifestations, US and RNS imaging findings,
FNAB results, surgical therapy, complications and pathological reports
were retrospectively reviewed. US, RNS and FNAB results were
categorized as either benign, malignant, suspicious or insufficient.
RESULTS: Females outnumbered males by a five to one ratio. Mean age
was 14.9 years. Nineteen nodules were benign (79%) and five malignant
(21%). All children were euthyroid. Benign nodules were soft, movable,
solitary and nontender. Malignant nodules were characterized by
localized tenderness, a multiglandular appearance, and fixation to
adjacent tissues. US and RNS gave no clue toward management since
cystic and hot nodules figured among malignant cases respectively. US
achieved 86% accuracy, 80% sensitivity and 88% specificity; RNS showed
26% accuracy, 80% sensitivity and 11% specificity; FNAB achieved 80%
accuracy, 60% sensitivity and 90% specificity. Suppressive thyroid
hormone therapy was useless in the few cases tried. Physical
examination findings, persistence of the nodule, progressive growth
and cosmetic appearance where the most common indications for surgery.
CONCLUSIONS: Present diagnostic modalities played a minor role in the
decision to withhold surgery. US was useful for aiming aspiration of
cystic nodules. RNS decided the functionality of the nodule, but its
accuracy was far from ideal. FNAB is a safe procedure whose greatest
help was to resolve in case of suspicious or malignant cytology that a
more radical procedure is needed. Clinical judgement as determined by
serial physical findings and suspicion continues to be the most
determinant factors in the management of thyroid nodules in children.
Thyroid nodules in childhood and
adolescence.Aust
N Z J Surg. 1994 Oct;64(10):676-8.
Thyroid nodules
are uncommon in the paediatric age group. One hundred and twenty-two
children and adolescents underwent thyroidectomy for nodular thyroid
disease in the Endocrine Surgical Unit at the Royal North Shore
Hospital over a 37 year period. In the adolescent age group (13-18
years) 99 thyroidectomies were performed and the pattern of thyroid
disease was similar to that seen in adults. In the prepubertal are
group (0-12 years), the major difference was the high incidence of
thyroid malignancy, especially in males. Of 23 prepubertal children
undergoing thyroidectomy for nodular disease, malignancy was found in
38% of boys and 13% of girls. Multicentric papillary cancer (66%) and
cervical lymph node metastases (80%) were very common, despite which
the long-term survival was excellent.
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