title: Diagnostic features of thyroid nodules in pediatrics.
abstract: OBJECTIVE
  To investigate a cohort of pediatric patients with thyroid nodules, defining histotype frequency and differences between subjects with hyperthyroidism and euthyroidism and benign and malignant nodules.
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  Consecutive cases from 9 Italian pediatric endocrinology centers for the last 10 years. Patients One hundred twenty pediatric patients with thyroid nodules. Intervention Doppler ultrasonography was performed in 71 subjects; scintiscan, in 56; fine-needle aspiration biopsy in 104; and 63 underwent surgery.
  
  
  METHODS
  The differences in clinical, laboratory, and ultrasonographic data between patients with hyperthyroidism and euthyroidism and malignant and benign nodules were evaluated.
  
  
  RESULTS
  One hundred fourteen patients had euthyroidism and 6, hyperthyroidism. The latter had more compressive signs (P=.003), greater nodule diameter (P=.02), intranodular vascularization pattern (P=.01), and increased scintiscan uptake (P<.001). Fine-needle aspiration biopsy disclosed benign lesions in 77 cases, malignant lesions in 19, and "suspicious" lesions in 8. Histologic examination disclosed 1 Hurthle cell and 5 follicular adenomas in patients with hyperthyroidism, whereas in patients with euthyroidism, 33 hyperplasic nodules, 19 carcinomas (14 papillary, 3 follicular, and 2 medullary), 3 follicular and 1 Hurthle cell adenoma, and 1 teratoma were detected. Nine patients had enhanced scintiscan uptake. Among the patients with euthyroidism, malignancies more frequently had palpable lymph nodes (P<.001), compressive signs (P=.004), microcalcifications (P<.001), intranodular vascularization (P=.01), and lymph node alterations (P<.001).
  
  
  CONCLUSIONS
  The diagnosis of pediatric thyroid nodules should be based on a stepwise evaluation that includes clinical, laboratory, and radiographic modalities. While laboratory assessments establish thyroid function, ultrasonographic imaging identifies clinically unapparent nodules and provides detailed nodule characterization for suspected malignant lesions. Scintiscan in patients with hyperthyroidism and fine-needle aspiration biopsy in patients with euthyroidism represent the next logical step.
authors.affiliation: Department of Pediatric Endocrinology and Diabetology, University of Torino, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126 Turin, Italy. corrand@libero.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Corrias
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mussa
authors.forename: Federico
authors.initials: F
authors.lastname: Baronio
authors.forename: Teresa
authors.initials: T
authors.lastname: Arrigo
authors.forename: Mariacarolina
authors.initials: M
authors.lastname: Salerno
authors.forename: Maria
authors.initials: M
authors.lastname: Segni
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Vigone
authors.forename: Roberto
authors.initials: R
authors.lastname: Gastaldi
authors.forename: Giuseppa
authors.initials: G
authors.lastname: Zirilli
authors.forename: Gerdi
authors.initials: G
authors.lastname: Tuli
authors.forename: Luciano
authors.initials: L
authors.lastname: Beccaria
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Iughetti
authors.forename: Silvia
authors.initials: S
authors.lastname: Einaudi
authors.forename: Giovanna
authors.initials: G
authors.lastname: Weber
authors.forename: Filippo
authors.initials: F
authors.lastname: De Luca
authors.forename: Alessandra
authors.initials: A
authors.lastname: Cassio
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016606:Thyroid Nodule / Q000175:diagnosis*