title: Thyroid nodules in children: what should be a minimal work-up preceding surgery?
abstract: Children with thyroid nodules undergo extensive and costly work-up before being referred to surgeons. We attempted to identify which is the minimal clinical workup necessary to develop an appropriate surgical management plan for euthyroid children diagnosed with thyroid nodules
  
  
  METHODS
  Case-control study including cases of thyroid nodules surgically intervened in a ten-year period at the University Pediatric Hospital. Following variables were studied: labs, physical exam, size of nodule, thyroid function tests, imaging. FNA findings, surgical procedure, and final pathology. The preoperative workup cost for each patient was estimated.
  
  
  RESULTS
  Population consisted of twenty-four children. Nineteen were female and 5 were male with an average age of 14 years Nodules were divided in malignant 54% and benign 46% Of the 19 female cases 42% were malignant mostly papillary cell ca cinoma (PCC). All male cases were PCC. Indications fo surgical intervention in patients with benign lesions w continuous growth and symptoms not resolving with m dical treatment. Most benign lesions were follicular adenoma. We had 75% FNA results and pathology results for all case studied. Of the cases preoperatively diagnosed as malignant neoplasm by FNA all of them were confirmed by pathology and there were no false positive malignancies. Preoperative workup cost average $580 USD.
  
  
  CONCLUSIONS
  A minimal workup algorithm is required before surgery in children with thyroid nodules. In a euthyroid child if a palpable nodule is found and it is accompanied by lymphadenopathy the suspicion for malignancy shoul be raised and FNA should be first line of evaluation. If no lymphadenopathy is present workup can proceed to US and progress to FNA evaluation if the nodule persists o grows. In symptomatic patients with small nodule. difficult to palpate or in smaller child, US-guided FNAwould be the best option.
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, UPR School of Medicine and the University Pediatric Hospital. titolugo@coqui.net
authors.forename: Humberto
authors.initials: H
authors.lastname: Lugo-Vicente
authors.forename: Nahir J
authors.initials: NJ
authors.lastname: Romero-Estremera
mesh_terms: D000293:Adolescent; D002648:Child; D019937:Diagnostic Techniques and Procedures; D005260:Female; D006801:Humans; D008297:Male; D011300:Preoperative Care; D012189:Retrospective Studies; D016606:Thyroid Nodule / Q000175:diagnosis* / Q000601:surgery