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Characteristics of thyroid nodules in infant with congenital hypothyroidism

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      Abstract

      Purpose

      This study aimed to assess the characteristics of thyroid nodules among infants diagnosed with congenital hypothyroidism.

      Methods

      A retrospective study of 660 infants (374 males, 286 females) diagnosed with congenital hypothyroidism was carried out at the Pediatric Endocrine Clinic in Soonchunhyang University Hospital, Korea, between May 2003 and February 2013. The average age at diagnosis was 1.16±1.68 months.

      Results

      Of the 28 patients (4.2%) with thyroid nodules, 17 (2.6%) had cystic thyroid nodules and 11 (1.6%) had solid thyroid nodules. There were no significant differences in gender or age between congenital hypothyroidism patients who hadthyroid nodules and those who did not. All nodules were asymptomatic. The average age at diagnosis of congenital hypothyroidism with nodules was 1.42±1.39 months. All detected nodules measured less than 1 cm in diameter. Twenty-two of the 28 infants (78.6%) had only one nodule, while multiple nodules were found in 6 infants (21.4%). Of the 28 infants diagnosed with nodules, 16 underwent thyroid ultrasonography during follow-up and 8 of them (50%) showed no signs of nodules at thyroid ultrasonography.

      Conclusion

      The prevalence of thyroid nodules in infants with congenital hypothyroidism was 4.2%. Most thyroid nodules were small in size and benign, disappearing during follow-up observation. We therefore conclude that thyroid nodules in infants with congenital hypothyroidism can simply be observed and do not require direct treatment.

      Related collections

      Most cited references 25

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      Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer.

      Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the publication of the American Thyroid Association's guidelines for the management of these disorders was published in 2006, a large amount of new information has become available, prompting a revision of the guidelines. Relevant articles through December 2008 were reviewed by the task force and categorized by topic and level of evidence according to a modified schema used by the United States Preventative Services Task Force. The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to optimal surgical management, radioiodine remnant ablation, and suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using ultrasound and serum thyroglobulin as well as those related to management of recurrent and metastatic disease. We created evidence-based recommendations in response to our appointment as an independent task force by the American Thyroid Association to assist in the clinical management of patients with thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.
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        Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging.

        The introduction of highly sensitive imaging techniques has made it possible to detect many non-palpable nodules, or "incidentalomas," in the thyroid. Discovery of these lesions raises concerns about their malignancy, but the optimal strategy for managing these lesions has not been clearly established. To review evidence about incidentalomas, including prevalence and risk for malignancy, and to provide recommendations for their evaluation and treatment. Literature searches for relevant articles published in the past 15 years in major English-language medical journals, review of selected articles published before this period, and reviews of bibliographies in text-books. Three studies on autopsy findings, 11 studies on ultrasonographic findings, and other reports on nonpalpable thyroid nodules were included. Data on the prevalence of nodules on autopsy and in ultrasonographic series, palpation compared with ultrasonography, the risk for malignancy in nodules found in irradiated glands, the natural history of thyroid nodules, and the prevalence of occult cancer were collated and reviewed. Prevalence of thyroid incidentalomas estimated from autopsy studies ranges from 30% to 60%. Studies comparing clinical palpation with thyroid imaging show a prevalence of 13% to 50%. Prospective studies of randomly selected patients have reported a prevalence of 19% to 67%. The risk for malignancy in asymptomatic nodules found in nonirradiated glands is 0.45% to 13% (mean +/- SD, 3.9% +/- 4.1%). High-resolution ultrasonography is sensitive and capable of detecting many small, nonpalpable thyroid nodules. Most of these lesions are benign. For most patients with nonpalpable nodules that are incidentally detected by thyroid imaging, simple follow-up neck palpation is sufficient.
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          Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography.

          Controversy remains as to the optimal management of patients with multiple thyroid nodules. The objective of this study was to determine the prevalence, distribution, and sonographic features of thyroid cancer in patients with solitary and multiple thyroid nodules. We describe a retrospective observational cohort study that was carried out from 1995 to 2003. The study was conducted in a tertiary care hospital. Patients with one or more thyroid nodules larger than 10 mm in diameter who had ultrasound-guided fine needle aspiration (FNA) were included in the study. The main outcome measures were prevalence and distribution of thyroid cancer and the predictive value of demographic and sonographic features. A total of 1985 patients underwent FNA of 3483 nodules. The prevalence of thyroid cancer was similar between patients with a solitary nodule (175 of 1181 patients, 14.8%) and patients with multiple nodules (120 of 804, 14.9%) (P = 0.95, chi(2)). A solitary nodule had a higher likelihood of malignancy than a nonsolitary nodule (P < 0.01). In patients with multiple nodules larger than 10 mm, cancer was multifocal in 46%, and 72% of cancers occurred in the largest nodule. Multiple logistic regression analysis of statistically significant features demonstrates that the combination of patient gender (P < 0.02), whether a nodule is solitary vs. one of multiple (P < 0.002), nodule composition (P < 0.01), and presence of calcifications (P < 0.001) can be used to assign risk of cancer to each individual nodule. Risk ranges from a 48% likelihood of malignancy in a solitary solid nodule with punctate calcifications in a man to less than 3% in a noncalcified predominantly cystic nodule in a woman. In a patient with one or more thyroid nodules larger than 10 mm in diameter, the likelihood of thyroid cancer per patient is independent of the number of nodules, whereas the likelihood per nodule decreases as the number of nodules increases. For exclusion of cancer in a thyroid with multiple nodules larger than 10 mm, up to four nodules should be considered for FNA. Sonographic characteristics can be used to prioritize nodules for FNA based on their individual risk of cancer.
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            Author and article information

            Affiliations
            [1 ]Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
            [2 ]Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
            Author notes
            Corresponding author: Dong Hwan Lee, MD. Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-gu, Seoul 140-743, Korea. Tel: +82-2-709-9341, Fax: +82-2-709-9135, ldh@ 123456schmc.ac.kr
            Journal
            Korean J Pediatr
            Korean J Pediatr
            KJP
            Korean Journal of Pediatrics
            The Korean Pediatric Society
            1738-1061
            2092-7258
            February 2014
            24 February 2014
            : 57
            : 2
            : 85-90
            3965800 10.3345/kjp.2014.57.2.85
            Copyright © 2014 by The Korean Pediatric Society

            This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

            Funding
            Funded by: Soonchunhyang University Research Fund
            Categories
            Original Article

            Pediatrics

            infant, ultrasonography, congenital hypothyroidism, thyroid nodule

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