title: Features and Outcome of Autonomous Thyroid Nodules in Children: 31 Consecutive Patients Seen at a Single Center.
abstract: Most thyroid nodules are benign and their accurate identification can avoid unnecessary procedures. In adult patients, documentation of nodule autonomy is accepted as reassurance of benign histology and as justification to forgo biopsy or thyroidectomy. In contrast, the negative predictive value of nodule autonomy in children is uncertain. Some recent publications recommend surgical resection as initial management, but few address the degree of TSH suppression or the specific scintigraphic criteria used to diagnose autonomy.
  
  
  
  The objective of the study was to study the presenting features and cancer risk of children with autonomous nodules.
  
  
  
  Medical records of all 31 children diagnosed with autonomous nodules at our center from 2003 to 2014 were retrospectively reviewed.
  
  
  
  All children met full diagnostic criteria for autonomous nodules, defined by both autonomous123I uptake into the nodule and the suppression of uptake in the normal thyroid parenchyma on scintigraphy performed during hypothyrotropinemia. The median age of presentation was 15 years (range 3-18 y) with a female to male ratio of 15:1. Fifty-eight percent of patients had solitary nodules and 42% had multiple nodules. The median size of each patient's largest autonomous nodule was 39 mm (range 18-67 mm). Most of the children in this series (68%) had diagnostic biopsies and/or operative pathology of their largest autonomous nodule, which showed benign cytology or histology in all cases.
  
  
  
  In this pediatric series, the cancer rate observed in biopsied or resected autonomous nodules was 0%. Whereas larger studies are needed to confirm our findings, these results agree with earlier reports suggesting that thyroid cancer is rare in rigorously defined autonomous nodules and support that conservative management may be offered to selected children who meet strict diagnostic criteria for autonomous nodules, deferring definitive therapies until adulthood when the risks of thyroidectomy and131I ablation are lower.
authors: Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115.
authors: Samantha
authors: S
authors: Ly
authors: Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115.
authors: Mary C
authors: MC
authors: Frates
authors: Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115.
authors: Carol B
authors: CB
authors: Benson
authors: Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115.
authors: Hope E
authors: HE
authors: Peters
authors: Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115.
authors: Frederick D
authors: FD
authors: Grant
authors: Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115.
authors: Laura A
authors: LA
authors: Drubach
authors: Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115.
authors: Stephan D
authors: SD
authors: Voss
authors: Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115.
authors: Henry A
authors: HA
authors: Feldman
authors: Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115.
authors: Jessica R
authors: JR
authors: Smith
authors: Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115.
authors: Justine
authors: J
authors: Barletta
authors: Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115.
authors: Monica
authors: M
authors: Hollowell
authors: Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115.
authors: Edmund S
authors: ES
authors: Cibas
authors: Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115.
authors: Francis D
authors: FD
authors: Moore
authors: Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115.
authors: Biren
authors: B
authors: Modi
authors: Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115.
authors: Robert C
authors: RC
authors: Shamberger
authors: Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115.
authors: Stephen A
authors: SA
authors: Huang
mesh_terms: D000293:Adolescent; D044963:Biopsy, Fine-Needle; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D016606:Thyroid Nodule / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology