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Gallant JN, Weiss VL, Chen SC, Liang J, Belcher RH, Ye F, Correa H, Wang H. Hashimoto's Thyroiditis and the Risk of Papillary Thyroid Cancer in Children. Cancers (Basel) 2023; 15:4902. [PMID: 37835596 PMCID: PMC10572053 DOI: 10.3390/cancers15194902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/09/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023] Open
Abstract
The association between Hashimoto's thyroiditis (HT) and pediatric thyroid cancer is controversial. Most studies examining this connection have been based on adults, and larger studies in children are lacking. We performed a retrospective study of all sequential pediatric patients who underwent a thyroidectomy for a neoplasm at our institution over a twenty-year period in order to explore the link between HT and pediatric thyroid cancer. A total of 153 patients, median age 16.5 (interquartile range [IQR] 14.2-18.3) years, underwent thyroid surgery for a neoplasm. Patients were mainly female (80%) and White (84%). Median follow-up was 58.6 (IQR 20.7-105.4) months. Thirty-five (23%) patients had HT. Patients who underwent thyroid surgery and had HT were more likely to harbor a malignant neoplasm (p = 0.05); specifically, papillary thyroid carcinoma (PTC, p = 0.02). There was a difference in the distribution of HT among the subtypes of PTC (p = 0.03). Despite this, there was no difference in terms of survival between patients with/without HT. In conclusion, children with a thyroid malignancy, specifically, PTC, are more likely to have HT. The association between HT and pediatric PTC appears to be subtype-specific but does not seem to affect patient survival.
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Affiliation(s)
- Jean-Nicolas Gallant
- Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Vivian L. Weiss
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Sheau-Chiann Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Jiancong Liang
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Monroe Carell Jr. Children’s Hospital, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Ryan H. Belcher
- Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Monroe Carell Jr. Children’s Hospital, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Fei Ye
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Hernan Correa
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Monroe Carell Jr. Children’s Hospital, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Huiying Wang
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Monroe Carell Jr. Children’s Hospital, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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Januś D, Wójcik M, Taczanowska-Niemczuk A, Kiszka-Wiłkojć A, Kujdowicz M, Czogała M, Górecki W, Starzyk JB. Ultrasound, laboratory and histopathological insights in diagnosing papillary thyroid carcinoma in a paediatric population: a single centre follow-up study between 2000-2022. Front Endocrinol (Lausanne) 2023; 14:1170971. [PMID: 37274328 PMCID: PMC10233204 DOI: 10.3389/fendo.2023.1170971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/03/2023] [Indexed: 06/06/2023] Open
Abstract
Background Papillary thyroid carcinoma (PTC) often coincides with autoimmune thyroiditis (AIT); whether this association is incidental or causal remains debated. Objective To evaluate the ultrasonographic, laboratory, and histopathological features of PTC in paediatric patients with and without AIT and its relationship to puberty. Design A retrospective cohort study. Patients and methods A retrospective analysis of medical records of 90 patients (69; 76.7% females). The mean age at PTC diagnosis was 13.8 years [range 6-18]. All patients were evaluated ultrasonographically before thyroid surgery. Thyroid nodules were categorised using the European Thyroid Imaging Reporting and Data System (EU-TIRADS PL), and cytopathology was assessed using Bethesda criteria. Neck ultrasound results and thyroid and autoimmune status were correlated with histopathological PTC assessment. Results The coexistence of PTC and AIT was found in 48.9% (44/90) of patients. The percentage of AIT was increasing with age; AIT was present only in 1/3 of prepubertal, close to 50% in pubertal, and over 60% in adolescent patients. The youngest patients (aged <10 years old) presented more often with goitre and lymphadenopathy and less often with AIT than adolescents (15-18 years of age). There were no differences in TPOAb, TgAb, and TSH levels between the age subgroups. Presurgical TgAb levels were higher than those of TPOAb in the youngest patients. Histopathological analysis revealed that the solid subtype was observed more often in prepubertal children and diffuse sclerosing in children below 14 years of age, whereas the classic subtype dominated in late pubertal. Univariate and multivariate analyses revealed that lymph nodes metastases (LNM) were associated with PTC diameter and fT4 level, whereas extrathyroidal extension with age and angioinvasion with PTC diameter and age. The correlations between age and fibrosis, and the presence of psammoma bodies in malignant tissues were close to significant. We did not observe an association between TSH levels and the presence of autoimmunity and PTC variables. Conclusions In paediatric patients the natural course of PTC may be less aggressive in adolescent patients than in younger children (especially < 10 years of age). We suggest that pre-operative evaluation of paediatric patients with thyroid nodules could include apart from assessment of thyroid hormones, evaluation of TPOAb, TgAb, and TRAb together with comprehensive neck ultrasonography.
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Affiliation(s)
- Dominika Januś
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University, Medical College, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children’s Hospital, Krakow, Poland
| | - Małgorzata Wójcik
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University, Medical College, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children’s Hospital, Krakow, Poland
| | - Anna Taczanowska-Niemczuk
- Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University, Medical College, Krakow, Poland
- Department of Pediatric Surgery, University Children’s Hospital, Krakow, Poland
| | - Aleksandra Kiszka-Wiłkojć
- Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University, Medical College, Krakow, Poland
- Department of Pediatric Surgery, University Children’s Hospital, Krakow, Poland
| | - Monika Kujdowicz
- Department of Pathology, University Children’s Hospital, Krakow, Poland
- Department of Pathomorphology, Jagiellonian University, Medical College, Krakow, Poland
| | - Małgorzata Czogała
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University, Medical College, Krakow, Poland
- Department of Pediatric Oncology and Hematology, University Children’s Hospital, Krakow, Poland
| | - Wojciech Górecki
- Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University, Medical College, Krakow, Poland
- Department of Pediatric Surgery, University Children’s Hospital, Krakow, Poland
| | - Jerzy B. Starzyk
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University, Medical College, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children’s Hospital, Krakow, Poland
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Januś D, Kujdowicz M, Wójcik M, Taczanowska-Niemczuk A, Kiszka-Wiłkojć A, Górecki W, Starzyk JB. Ultrasound evolution of parenchymal changes in the thyroid gland with autoimmune thyroiditis in children prior to the development of papillary thyroid carcinoma - a follow-up study. Front Endocrinol (Lausanne) 2023; 14:1172823. [PMID: 37124746 PMCID: PMC10130420 DOI: 10.3389/fendo.2023.1172823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/29/2023] [Indexed: 05/02/2023] Open
Abstract
Background Follicular cell-derived thyroid carcinoma represents the vast majority of paediatric thyroid cancers (TCs). Papillary thyroid carcinoma (PTC) accounts for over 90% of all childhood TC cases, and its incidence in paediatric patients is increasing. The objective of this follow-up study was to present the outcome of ultrasound (US) and laboratory monitoring of paediatric patients with autoimmune thyroiditis (AIT) prior to the development of PTC. Patients and methods This prospective study included 180 children and adolescents (132 females; 73.3%) with a suspicion of thyroid disorder referred to the Outpatient Endocrine Department. The patients were divided into four groups: 1) 28 patients with a mean age of 10.7 [standard deviation (SD), 3.1] y, in whom PTC was detected during the active surveillance of AIT [AIT(+), PTC(+) follow up (F)]; 2) 18 patients with a mean age of 12.8 (SD, 3.4) y, in whom PTC and AIT were detected upon admission (A) [AIT(+), PTC(+) A]; 3) 45 patients with a mean age of 13.0 (SD, 3.4) y, in whom PTC was detected upon admission and AIT was excluded [AIT(-), PTC(+) A]; and 4) an age- and sex-matched control group of 89 patients with AIT and with a mean age of 9.4 (SD, 3.0) y. The analysis included clinical, US, and laboratory assessment results of children on admission (groups 1-4) and during follow-up (groups 1 and 4) in the Paediatric Endocrine Outpatient Department. Results Upon admission of those in group 1, the US evaluation revealed a hypoechogenic thyroid gland in 12 and an irregular normoechogenic gland in 16 patients. US monitoring revealed an increase in thyroid echogenicity and an increased irregularity of the thyroid structure during the follow-up period of all of the patients from group 1. Such changes were not noticed in group 4. PTC was diagnosed at the mean time of 3.6 y (3 mo-9 y) since AIT confirmation in group 1. The mean maximum PTC diameter as per the US was significantly smaller in group 1 than in groups 2 and 3 [13.2 (10.8) mm vs. 22.2 (12.8) and 22.05 (15.4) mm]. Fewer patients in group 1 were referred to 131I than in groups 2 and 3 (71.4% vs. 94.4 and 93.3%). Interestingly, significant differences were observed in the thyroglobulin antibody (TgAb)/thyroid peroxidase antibody (TPOAb) ratio between groups 2 and 3, as opposed to group 4, at the beginning of observation [15.3 (27.6) and 3.5 (8.8] vs. 0.77 (1.9)]. In group 1, after the follow-up, an increase in the TgAb/TPOAb ratio was observed [1.2 (9.8) to 5.2 (13.5)]. There were no significant differences between groups 1-3 in labeling index Ki67, lymph nodes metastasis, extrathyroidal extension, and angioinvasion. There were no associations between thyroid-stimulating hormone, TgAb, and the extent of the disease. Conclusion The use of thyroid US focused on the search for developing tumours in the routine follow-up of patients with AIT may not only help in the early detection of thyroid malignancies that are not clinically apparent but may also influence the invasiveness of oncological therapy and reduce the future side effects of 131I therapy. We propose that the repeat evaluation of TPOAb and TgAb warrants further exploration as a strategy to determine TC susceptibility in paediatric patients with AIT in larger multicentre studies.
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Affiliation(s)
- Dominika Januś
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital in Krakow, Krakow, Poland
| | - Monika Kujdowicz
- Department of Pathomorphology, Jagiellonian University Medical College, Krakow, Poland
- Department of Pathology, University Children Hospital in Krakow, Krakow, Poland
| | - Małgorzata Wójcik
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital in Krakow, Krakow, Poland
| | - Anna Taczanowska-Niemczuk
- Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric Surgery, University Children Hospital in Krakow, Krakow, Poland
| | - Aleksandra Kiszka-Wiłkojć
- Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric Surgery, University Children Hospital in Krakow, Krakow, Poland
| | - Wojciech Górecki
- Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric Surgery, University Children Hospital in Krakow, Krakow, Poland
| | - Jerzy B. Starzyk
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital in Krakow, Krakow, Poland
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van Straalen JW, Baas L, Giancane G, Grebenkina L, Brunner J, Vega-Cornejo G, Chasnyk VG, Harel L, Appenzeller S, Gervais E, de Roock S, Wulffraat NM, Ruperto N, Swart JF. Juvenile idiopathic arthritis patients with positive family history of autoimmune thyroid disease might benefit from serological screening: analysis of the international Pharmachild registry. Pediatr Rheumatol Online J 2023; 21:19. [PMID: 36810111 PMCID: PMC9945712 DOI: 10.1186/s12969-023-00802-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/14/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Little is known about the association between juvenile idiopathic arthritis (JIA) and autoimmune thyroid disease (AITD) and therefore there are no indications for AITD screening in this population, which is possible using standard blood tests. The objective of this study is to determine the prevalence and predictors of symptomatic AITD in JIA patients from the international Pharmachild registry. METHODS Occurrence of AITD was determined from adverse event forms and comorbidity reports. Associated factors and independent predictors for AITD were determined using univariable and multivariable logistic regression analyses. RESULTS The prevalence of AITD after a median observation period of 5.5 years was 1.1% (96/8965 patients). Patients who developed AITD were more often female (83.3% vs. 68.0%), RF positive (10.0% vs. 4.3%) and ANA positive (55.7% vs. 41.5%) than patients who did not. AITD patients were furthermore older at JIA onset (median 7.8 years vs. 5.3 years) and had more often polyarthritis (40.6% vs. 30.4%) and a family history of AITD (27.5% vs. 4.8%) compared to non-AITD patients. A family history of AITD (OR = 6.8, 95% CI: 4.1 - 11.1), female sex (OR = 2.2, 95% CI: 1.3 - 4.3), ANA positivity (OR = 2.0, 95% CI: 1.3 - 3.2) and older age at JIA onset (OR = 1.1, 95% CI: 1.1 - 1.2) were independent predictors of AITD on multivariable analysis. Based on our data, 16 female ANA positive JIA patients with a family history of AITD would have to be screened during ±5.5 years using standard blood tests to detect one case of AITD. CONCLUSIONS This is the first study to report independent predictor variables for symptomatic AITD in JIA. Female ANA positive JIA patients with positive family history are at increased risk of developing AITD and thus might benefit from yearly serological screening.
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Affiliation(s)
- Joeri W. van Straalen
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
| | - Laurie Baas
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
| | - Gabriella Giancane
- grid.419504.d0000 0004 1760 0109Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy ,grid.5606.50000 0001 2151 3065Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Lyudmila Grebenkina
- Pediatric Department, Togliatti City Clinical Hospital №5, Togliatti, Russia
| | - Jurgen Brunner
- grid.5361.10000 0000 8853 2677Pediatric Rheumatology, Department of Pediatrics, Medical University Innsbruck, Innsbruck, Austria ,grid.465811.f0000 0004 4904 7440Danube Private University, Krems, Austria
| | - Gabriel Vega-Cornejo
- Clínica Pediátrica de Reumatología y Enfermedades Autoinmunes (CREA), Hospital México Americano, Guadalajara, Mexico
| | - Vyacheslav G. Chasnyk
- grid.445931.e0000 0004 0471 4078Department of Hospital Pediatrics, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Liora Harel
- grid.414231.10000 0004 0575 3167Pediatric Rheumatology Unit, Schneider Children’s Medical Center, Petach-Tikvah, Israel ,grid.12136.370000 0004 1937 0546Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Simone Appenzeller
- grid.411087.b0000 0001 0723 2494Department of Orthopedics, Rheumatology and Traumatology, School of Medical Science, University of Campinas, Campinas, Brazil
| | - Elisabeth Gervais
- grid.411162.10000 0000 9336 4276Rheumatology, Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers, France
| | - Sytze de Roock
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
| | - Nico M. Wulffraat
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
| | - Nicolino Ruperto
- grid.419504.d0000 0004 1760 0109UOSID Centro trial, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Joost F. Swart
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
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Molecular Landscape of Pediatric Thyroid Cancer: A Review. Diagnostics (Basel) 2022; 12:diagnostics12123136. [PMID: 36553142 PMCID: PMC9776958 DOI: 10.3390/diagnostics12123136] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/03/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022] Open
Abstract
Thyroid carcinomas (TC) are rare in the pediatric population; however, they constitute the most common endocrine malignancy. Despite some similarities with adult carcinomas, they have distinct clinical behavior and responses to therapy due to their unique pathology and molecular characteristics. The age cut-off used for defining the pediatric age group has been variable across different studies, and the universally accepted recommendations influence accurate interpretation of the available data. Moreover, factors such as radiation exposure and germline mutations have greater impact in children than in adults. Papillary TC is the most common and the most evaluated pediatric TC. Others, including follicular, poorly differentiated and medullary carcinomas, are rarer and have limited available literature. Most studies are from the West. Asian studies are primarily from Japan, with few from China, India, Saudi Arabia and Republic of Korea. This review provides a comprehensive account of the well-established and novel biomarkers in the field, including point mutations, fusions, miRNA, and thyroid differentiation genes. Familial and syndromic associations are also discussed. Current management guidelines for pediatric patients are largely derived from those for adults. An awareness of the molecular landscape is essential to acknowledge the uniqueness of these tumors and establish specific diagnostic and therapeutic guidelines.
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Elastographic Evaluation of Thyroid Nodules in Children and Adolescents with Hashimoto’s Thyroiditis and Nodular Goiter with Reference to Cytological and/or Histopathological Diagnosis. J Clin Med 2022; 11:jcm11216339. [DOI: 10.3390/jcm11216339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/10/2022] [Accepted: 10/22/2022] [Indexed: 11/16/2022] Open
Abstract
There are data indicating the coexistence of papillary thyroid carcinoma and autoimmune thyroiditis (AIT) in children. The aim of the study was elastographic evaluation of thyroid nodules in children and adolescents with AIT and nodular goiter in relation to cytological and/or histopathological diagnosis. We examined 215 children (57 boys and 158 girls) with 261 thyroid nodules (143 non-AIT and 118 AIT). All study participants underwent a conventional ultrasound examination with elastography followed by fine needle aspiration biopsy (FNAB). Abnormal Strain Ratio (SR ≥ 5) was observed in 36 non-AIT nodules and 15 AIT nodules. Papillary thyroid carcinoma was diagnosed in 5 patients (2% of all investigated nodules). SR of malignant thyroid nodules was statistically higher in comparison to SR of benign nodules both in the group of non-AIT (6 ± 4 vs. 3.67 ± 2.62, p = 0.024) and AIT nodules (6.3 ± 0.01 vs. 2.92 ± 1.89, p = 0.047). Comparison of non-AIT and AIT benign nodules revealed that SR was higher in non-AIT nodules (3.67 ± 2.62 vs. 2.92 ± 1.89, p = 0.01). We observed a strong positive correlation (R = 1) between TSH concentration and SR ratio in the group of all malignant thyroid nodules. Autoimmune inflammatory process of the thyroid gland does not limit the use of elastography in the diagnosis of thyroid nodules in children.
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Keefe G, Culbreath K, Cherella CE, Smith JR, Zendejas B, Shamberger RC, Richman DM, Hollowell ML, Modi BP, Wassner AJ. Autoimmune Thyroiditis and Risk of Malignancy in Children with Thyroid Nodules. Thyroid 2022; 32:1109-1117. [PMID: 35950619 DOI: 10.1089/thy.2022.0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: It is uncertain whether the presence of autoimmune thyroiditis (AIT) increases the risk of thyroid cancer in children with thyroid nodules. This study evaluated the association between AIT and thyroid cancer in pediatric patients with thyroid nodules. Methods: A cross-sectional study was performed of pediatric patients (<19 years old) with a thyroid nodule (≥1 cm) who underwent fine-needle aspiration in an academic pediatric thyroid center. AIT was defined by the presence of thyroid autoantibodies or diffusely heterogeneous sonographic echotexture. The primary outcome was diagnosis of thyroid cancer. The association of AIT with thyroid cancer was evaluated with univariable and multivariable logistic regression. Associations of AIT with subject and nodule characteristics were also assessed. Results: Four hundred fifty-eight thyroid nodules in 385 patients (81% female) were evaluated at a median age of 15.5 years (interquartile range 13.5-17.0). Thyroid cancer was present in 108 nodules (24%). AIT was present in 95 subjects (25%) and was independently associated with an increased risk of thyroid cancer (multivariable odds ratio [OR] 2.19, 95% confidence interval [CI] 1.32-3.62). Thyroid cancer was also independently associated with younger age, nodule size, and solitary nodules, but was not associated with serum thyrotropin concentration. AIT was not associated with the likelihood of subjects undergoing thyroid surgery (p = 0.17). AIT was less commonly associated with follicular thyroid carcinoma than with papillary thyroid carcinoma (OR 0.22, CI 0.05-1.06). Among papillary thyroid carcinomas, AIT was strongly associated with the diffuse sclerosing variant (OR 4.74, CI 1.33-16.9). AIT was not associated with the extent of local, regional, or distant disease at thyroid cancer diagnosis. Conclusions: AIT is independently associated with an increased risk of thyroid cancer in children with thyroid nodules. These findings suggest that the evaluation of thyroid autoantibodies and thyroid echotexture may inform thyroid cancer risk assessment and surgical decision-making in children with thyroid nodules.
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Affiliation(s)
| | | | - Christine E Cherella
- Thyroid Center, Boston, Massachusetts, USA
- Division of Endocrinology, Department of Pediatrics, Boston, Massachusetts, USA
| | - Jessica R Smith
- Thyroid Center, Boston, Massachusetts, USA
- Division of Endocrinology, Department of Pediatrics, Boston, Massachusetts, USA
| | - Benjamin Zendejas
- Department of Surgery, Boston, Massachusetts, USA
- Thyroid Center, Boston, Massachusetts, USA
| | - Robert C Shamberger
- Department of Surgery, Boston, Massachusetts, USA
- Thyroid Center, Boston, Massachusetts, USA
| | - Danielle M Richman
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Monica L Hollowell
- Thyroid Center, Boston, Massachusetts, USA
- Department of Pathology; Boston Children's Hospital, Boston, Massachusetts, USA
| | - Biren P Modi
- Department of Surgery, Boston, Massachusetts, USA
- Thyroid Center, Boston, Massachusetts, USA
| | - Ari J Wassner
- Thyroid Center, Boston, Massachusetts, USA
- Division of Endocrinology, Department of Pediatrics, Boston, Massachusetts, USA
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8
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Cozzolino A, Filardi T, Simonelli I, Grani G, Virili C, Stramazzo I, Santaguida MG, Locantore P, Maurici M, Gianfrilli D, Isidori AM, Durante C, Pozza C. Diagnostic accuracy of ultrasonographic features in detecting thyroid cancer in the transition age: a meta-analysis. Eur Thyroid J 2022; 11:e220039. [PMID: 35521998 PMCID: PMC9254313 DOI: 10.1530/etj-22-0039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 11/08/2022] Open
Abstract
Context Significant uncertainty exists about the diagnostic accuracy of ultrasonographic (US) features used to predict the risk of thyroid cancer in the pediatric population. Moreover, there are no specific indications for thyroid nodule evaluation in patients during the transition age. Objective The meta-analysis aimed to address the following question: which thyroid nodule US features have the highest accuracy in predicting malignancy in the transition age. Methods We performed a meta-analysis of observational/cohort/diagnostic accuracy studies dealing with thyroid nodule sonography, reporting US features, and using histology as a reference standard for the diagnosis of malignancy and histology or cytology for the diagnosis of benignity in the transition age (mean/median age 12-21 years). Results The inclusion criteria were met by 14 studies, published between 2005 and 2020, including 1306 thyroid nodules (mean size 17.9 mm) from 1168 subjects. The frequency of thyroid cancer was 36.6%. The US features with the highest diagnostic odds ratio (DOR) for malignancy were the presence of suspicious lymph nodes (DOR: 56.0 (95% CI: 26.0-119.0)), a 'taller than wide' shape of the nodule (6.0 (95% CI: 2.0-16.0)), the presence of microcalcifications (13.0 (95% CI: 6.0-29.0)) and irregular margins (9.0 (95% CI: 5.0-17.0)). Heterogeneity among the studies was substantial. Conclusions Following the diagnosis of a thyroid nodule in the transition age, a thorough US examination of the neck is warranted. The detection of suspicious lymph nodes and/or thyroid nodules with a 'taller than wide' shape, microcalcifications, and irregular margins is associated with the highest risk of malignancy in the selection of nodules candidates for biopsy.
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Affiliation(s)
- Alessia Cozzolino
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Tiziana Filardi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Ilaria Simonelli
- Service of Medical Statistics and Information Technology, Fatebenefratelli Foundation for Health Research and Education, Rome, Italy
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Camilla Virili
- Endocrinology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ‘Sapienza’ University of Rome, Latina, Italy
| | - Ilaria Stramazzo
- Endocrinology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ‘Sapienza’ University of Rome, Latina, Italy
| | - Maria Giulia Santaguida
- Endocrinology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ‘Sapienza’ University of Rome, Latina, Italy
| | - Pietro Locantore
- Endocrinology Unit, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimo Maurici
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Daniele Gianfrilli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Carlotta Pozza
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - on behalf of TALENT Group
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
- Service of Medical Statistics and Information Technology, Fatebenefratelli Foundation for Health Research and Education, Rome, Italy
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
- Endocrinology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ‘Sapienza’ University of Rome, Latina, Italy
- Endocrinology Unit, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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9
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Newfield RS, Jiang W, Sugganth DX, Hantash FM, Lee E, Newbury RO. Mutational analysis using next generation sequencing in pediatric thyroid cancer reveals BRAF and fusion oncogenes are common. Int J Pediatr Otorhinolaryngol 2022; 157:111121. [PMID: 35397361 DOI: 10.1016/j.ijporl.2022.111121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 02/28/2022] [Accepted: 03/25/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND We previously described mutation rates of BRAFV600E, RAS, RET-PTC and PAX8-PPARγ in pediatric subjects with well-differentiated thyroid cancer (WDTC). We expanded the cohort adding next-generation sequencing (NGS) and assessed genotype-phenotype correlations. METHODS Single-center retrospective cohort examining thyroidectomy tissue blocks from consecutive pediatric WDTC patients between 2001 and 2015. Tissues were analyzed at Quest Diagnostics for BRAF, RAS mutations, RET-PTC and PAX8-PPARγ, and additional fusions, using standalone and NGS tests. WDTC included papillary (PTC), follicular (FTC) and follicular-variant PTC (FVPTC). RESULTS We genotyped 46 samples (36 females). Mean age at diagnosis was 14.7 years and the cohort comprised of mostly Hispanic (60.9%) and Caucasian (26.1%) patients. Mean follow-up was 3.5 years. Genetic alterations (GA) were noted in 69.6%, with BRAFV600E (n = 11), and RET-PTC (n = 8) detected only in PTC. GA were detected in 2/7 FTC (1 PAX8-PPARγ, 1 NRAS) and 6/10 FVPTC (3 PAX8-PPARγ, 1 STRN-ALK, 1 BRAFK601E, 1 NRAS). Patients with BRAFV600E were predominantly Hispanic (81.8%) and >15 years (81.8%), whereas 87.5% RET-PTC and 50% other-fusions occurred in patients ≤15 years (p = 0.044). Of the 29 PTC patients, 82.8% had GA: BRAFV600E (37.9%), RET-PTC (27.6%), 17.2% other fusion-oncogenes (2 -ALK, 3 -NTRK). Non-RET fusions had the highest vascular invasion (100%, p = 0.042 vs RET-PTC) and frequent lymphatic invasion (80%). GA were most common in PTC with cervical metastasis. CONCLUSIONS BRAFV600E was the most common single mutation, especially in older and Hispanic adolescents. All fusions combined are more common than BRAFV600E. NGS reveals a genetic basis in most pediatric WDTC, which may have implications for the role of molecular testing and systemic therapy.
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Affiliation(s)
- Ron S Newfield
- Division of Pediatric Endocrinology, University of California San Diego, And Rady Children's Hospital San Diego, California, 3020 Children's Way, MC 5103, San Diego, CA, 92123, United States.
| | - Wen Jiang
- Department of Otolaryngology, University of California San Diego, And Rady Children's Hospital of San Diego, 3030 Children's Way, Suite 402, San Diego, CA, 92123-4295, United States.
| | - Daniel X Sugganth
- Hematology & Oncology, Quest Diagnostics Nichols Institute, 33608 Ortega Highway, San Juan Capistrano, CA, 92675, United States.
| | - Feras M Hantash
- Hematology & Oncology, Quest Diagnostics Nichols Institute, 33608 Ortega Highway, San Juan Capistrano, CA, 92675, United States.
| | - Euyhyun Lee
- Altman Clinical and Translational Research Institute, University of California San Diego, 9452 Medical Center Dr N, La Jolla, CA, 92037, United States.
| | - Robert O Newbury
- Department of Pathology, Rady Children's Hospital, University of California, San Diego 3020 Children's Way, MC 5007, San Diego, CA, 92123, United States.
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10
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Arnaoutoglou C, Keivanidou A, Dragoutsos G, Tentas I, Meditskou S, Zarogoulidis P, Matthaios D, Sardeli C, Ioannidis A, Perdikouri EI, Giannopoulos A. Factors Affecting the Nuclei in Newborn and Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074226. [PMID: 35409906 PMCID: PMC8998771 DOI: 10.3390/ijerph19074226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 02/01/2023]
Abstract
It is known that children are more sensitive to the effects of medical treatments and environment than adults. Today there is limited information regarding the differences in genotoxic effects in children. The micronucleus assay is a method that is used to monitor genotoxicity, and it was validated several years before. Today there is international interest for exfoliated buccal cells. Most of the micronuclei studies in children have been performed with the analyses of lymphocytes. However, there is vast interest in using exfoliated cells from the oral cavity. The reason is that other type of cells are acquired non-invasively, this is an important issue in paediatric cohorts. Unfortunately a limitation of measuring micronuclei frequency is that it has been observed to be low in newborns and on the other hand there are a large number of patients and cell sample counts. It has been observed that radiation exposure and environmental pollutants increase the micronuclei frequency in newborn and children. Regarding the medical treatments, there is little data and several studies are needed to optimise the doses. There is the need to observe if there is a relationship between micronuclei in lymphocytes and exfoliated cells and to identify the baseline of the micronuclei levels. Moreover, we evaluate the changes in response to the toxic agents. Prospective cohorts studies will clarify the predictive value of micronuclei for cancer and chronic diseases for both children and adults. Novel molecular technologies will assist in the elucidation of different biological pathways and molecular mechanisms connected with the micronulcei levels in newborn and children.
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Affiliation(s)
- Christos Arnaoutoglou
- Department of Obstetrics & Gynecology, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Anastasia Keivanidou
- Pediatric Department, Aristotle University of Thessaloniki, AHEPA General Hospital, 54124 Thessaloniki, Greece; (A.K.); (A.G.)
| | - Georgios Dragoutsos
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 69132 Komotini, Greece;
| | - Ioannis Tentas
- Department of Obstetrics & Gynecology, General Hospital of Giannitsa, 58100 Giannitsa, Greece;
| | - Soultana Meditskou
- Laboratory of Histology and Embryology, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Paul Zarogoulidis
- Pulmonary Department, General Clinic Euromedica, 54124 Thessaloniki, Greece
- Correspondence:
| | | | - Chrysanthi Sardeli
- Department of Pharmacology & Clinical Pharmacology, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Aris Ioannidis
- Department of Surgery, “Genesis” Private Clinic, 54124 Thessaloniki, Greece;
| | | | - Andreas Giannopoulos
- Pediatric Department, Aristotle University of Thessaloniki, AHEPA General Hospital, 54124 Thessaloniki, Greece; (A.K.); (A.G.)
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11
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Tuli G, Munarin J, Scollo M, Quaglino F, De Sanctis L. Evaluation of the efficacy of EU-TIRADS and ACR-TIRADS in risk stratification of pediatric patients with thyroid nodules. Front Endocrinol (Lausanne) 2022; 13:1041464. [PMID: 36482990 PMCID: PMC9723319 DOI: 10.3389/fendo.2022.1041464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pediatric thyroid nodules have a lower prevalence but a higher rate of malignancy (ROM) than those in adults. Ultrasound features suspected of malignancy lead to fine needle aspiration biopsy (FNAB) and subsequent cytological determination, upon which management is decided. Based on the characteristics of ultrasound, to standardize clinician decisions and avoid unnecessary FNAB, the European Thyroid Association and the American Radiology College have established guidelines for Thyroid Imaging, Reporting and Data System (EU-TIRADS and ACR-TIRADS) for ROM stratification of thyroid nodules. The aim of this study is to evaluate the diagnostic performance of ACR-TIRADS and EU-TIRADS in pediatric age. MATERIALS AND METHODS Subjects younger than 18 years of age with thyroid nodules greater than 0.5 cm observed in the 2000-2020 period were included. RESULTS Data from 200 subjects were collected. The overall ROM was 13%, rising to 26% if nodules with a diameter >1 cm were considered. Patients with a malignant nodule were more likely to have a higher EU-TIRADS score (p=0.03). Missed cancer diagnoses were 26.9%. Using the EU-TIRADS system, 40% of FNABs could have been avoided, while this scoring system would have resulted in FNAB being performed in 12% of cases where the assessment of ultrasound features would not recommend FNAB. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 73.1%, 57.1%, 73.1%, and 50%, respectively. Even considering the ACR-TIRADS, a higher score correlated with a higher ROM (p<0.001). This system missed 6 diagnoses of cancer (23.1%). Using the ACR-TIRADS system, 45.3% of FNABs could have been avoided, while FNAB should have been performed in 12% of cases where it was not recommended by ultrasound characteristics. Sensitivity, specificity, PPV and NPV were 76.9%, 50%, 76.9%, and 42.9%, respectively. CONCLUSION The present study confirms the correspondence of the EU-TIRADS and ACR-TIRADS categories with respect to malignancy but indicates not entirely satisfactory performance compared to FNAB alone. However, the use of the two TIRADS systems should be encouraged in multicentre studies to increase their performance and establish paediatric-specific points in the scoring criteria.
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Affiliation(s)
- Gerdi Tuli
- Department of Health and Pediatric Sciences, University of Turin, Turin, Italy
- Department of Pediatric Endocrinology, Regina Margherita Children’s Hospital, Turin, Italy
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- *Correspondence: Gerdi Tuli,
| | - Jessica Munarin
- Department of Pediatric Endocrinology, Regina Margherita Children’s Hospital, Turin, Italy
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Mariapia Scollo
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Francesco Quaglino
- Department of General Surgery, "Maria Vittoria" Hospital Azienda Sanitaria Locale (ASL) Città di Torino, Turin, Italy
| | - Luisa De Sanctis
- Department of Pediatric Endocrinology, Regina Margherita Children’s Hospital, Turin, Italy
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
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Guo K, Qian K, Shi Y, Sun T, Chen L, Mei D, Dong K, Gu S, Liu J, Lv Z, Wang Z. Clinical and Molecular Characterizations of Papillary Thyroid Cancer in Children and Young Adults: A Multicenter Retrospective Study. Thyroid 2021; 31:1693-1706. [PMID: 34514877 DOI: 10.1089/thy.2021.0003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Papillary thyroid carcinoma (PTC) is a rare malignancy in children and young adults (CAYA). It often presents with aggressive disease patterns and advanced stages, which are clinically distinct from those in adult patients. In this study, we sought to characterize and better understand the clinical variants of PTC in CAYA and explore the underlying mechanisms. Methods: CAYA patients (age ≤18 years) diagnosed with PTC between June 2006 and June 2018 were retrospectively recruited from five hospitals. Demographic information, pathological data, and follow-up status were recorded. Tumor samples obtained from 20 children (mean age 15.15 years) and 10 adults (mean age 38.80 years) underwent comprehensive whole transcriptome sequencing. Differentially expressed genes (DEGs), mutational landscape, and immune infiltration were analyzed. Results: A total of 217 CAYA-PTC patients (162 females and 55 males) with an average age of 14.38 ± 3.53 years (range 2-18) were included. Lymph node metastasis (LNM) was observed in 85.71%, of which 57.60% were in the lateral cervical compartment. Disease recurred in 28 of 217 (12.90%) patients with a median follow-up of 4.76 years. Multivariate logistic regression analysis revealed that age, bilateral disease, extrathyroidal extension, and coexisting Hashimoto's thyroiditis (co-HT) were independent risk factors for LNM, while co-HT was the only risk factor for recurrence. Using whole transcriptome sequencing of PTC tissues, we identified 301 DEGs. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses showed that differences in immune mediators played important roles, based on the distributions of mutation frequencies, types, and expression levels between CAYA and adult patients. Based on the integrated data sets, we identified significantly mutated immune genes, cluster of differentiation 24 (CD24), coagulation factor 12 (F12), coagulation factor 5 (F5), integrin subunit alpha 3 (ITGA3), and retinoic acid early transcript 1L (RAET1L), which were then verified by immunohistochemistry. Furthermore, resting mast cells, resting natural killer cells, plasma cells, and regulatory T cells were different in the CAYA-PTC group and correlated with the expression of immune checkpoints. Conclusions: There are considerable variabilities that may contribute to the different clinical presentations between CAYA and adult PTC patients, among which the decrease in protective immune cells may be a factor. Collectively, our results add to the possible biological mechanisms involved in CAYA-PTC.
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Affiliation(s)
- Kai Guo
- Department of Head and Neck Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Kai Qian
- Department of Head and Neck Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Yuan Shi
- Department of Head and Neck Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Tuanqi Sun
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Licai Chen
- Department of General Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
| | - Dongyu Mei
- Department of Pediatric Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kuiran Dong
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Song Gu
- Department of Pediatric Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiangbin Liu
- Department of General Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
| | - Zhibao Lv
- Department of General Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
| | - Zhuoying Wang
- Department of Head and Neck Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
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13
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Tuli G, Munarin J, Agosto E, Matarazzo P, Quaglino F, Mormile A, de Sanctis L. Predictive factors of malignancy in pediatric patients with thyroid nodules and performance of the Italian classification (SIAPEC 2014) in the outcome of the cytological FNA categories. Endocrine 2021; 74:365-374. [PMID: 34128176 PMCID: PMC8497296 DOI: 10.1007/s12020-021-02784-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/31/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE The rate of malignancy (ROM) among pediatric studies using the Bethesda System is 39.5% and 41.5% for atypia of undetermined significance/follicular lesion of undetermined significance and for suspected follicular neoplasm, respectively. Data reported on the basis of Bethesda System showed lower ROM in adults with indeterminate nodules (30.5 and 28.9% respectively). Studies on adults based on the Italian Society of Anatomic Pathology and Cytology (SIAPEC) classification, report ROM of 14.2% for TIR3a and 44.6% for TIR3b category, showing greater sensitivity in detecting malignancy. To date, no performance data are available about SIAPEC classification in pediatric age. METHODS Retrospective data were collected from 200 pediatric subjects with thyroid nodules in the period 2000-2020. RESULTS The distribution of cytological categories after fine needle aspiration biopsy (FNAB) was 7 TIR1, 4 TIR1c, 22 TIR2, 14 TIR3a, 9 TIR3b, 3 TIR4, and 16 TIR5. The surgical approach was performed in 40/200 subjects, with total ROM of 65% (0% for TIR1-TIR3a, 77.8% for TIR3b, and 100% for TIR4-TIR5). Total FNAB accuracy was 95%, while the sensibility and specificity were 92.3 and 92.6%, respectively. CONCLUSIONS The reported data seem to confirm a greater sensitivity of SIAPEC classification to identify malignancy within the indeterminate category also in pediatric age and not only in adulthood. This finding may orient clinicians toward clinical follow-up for the indeterminate TIR3a group and toward surgical approach with total thyroidectomy in the indeterminate TIR3b group, although this indication should be confirmed in further national multicenter studies including larger cohorts.
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Affiliation(s)
- Gerdi Tuli
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy.
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
| | - Jessica Munarin
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Erica Agosto
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Patrizia Matarazzo
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Francesco Quaglino
- Department of General Surgery, "Maria Vittoria" Hospital ASL Città di Torino, Turin, Italy
| | - Alberto Mormile
- Endocrinology, Diabetes and Metabolism Department and Center for Thyroid Diseases, Ordine Mauriziano Hospital, Turin, Italy
| | - Luisa de Sanctis
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
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15
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Yeker RM, Shaffer AD, Viswanathan P, Witchel SF, Mollen K, Yip L, Monaco SE, Duvvuri U, Simons JP. Chronic Lymphocytic Thyroiditis and Aggressiveness of Pediatric Differentiated Thyroid Cancer. Laryngoscope 2021; 132:1668-1674. [PMID: 34687456 PMCID: PMC9033882 DOI: 10.1002/lary.29908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/28/2021] [Accepted: 10/12/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS Hashimoto's Thyroiditis (HT) is a common cause of hypothyroidism. Among adults with differentiated thyroid cancer (DTC), HT appears to be associated with less severe disease burden. In the absence of information regarding HT and disease burden among children with DTC, we assessed the relationship between pediatric DTC severity and HT. STUDY DESIGN Retrospective cohort. METHODS Charts from 90 pediatric patients who underwent surgical removal of DTC from 2002 to 2017 at tertiary-care children's hospital were reviewed. Demographic, clinical, surgical, pathology, and outcome details were compared between patients with and without HT. Consistency among diagnostic modalities of HT was also evaluated. RESULTS Median age at presentation was 16.0 years (range 4.2-18.9 years). Twenty-two patients were male (24%). Forty-five patients (50%) had HT based on presence of thyroid autoantibodies and/or surgical pathology findings and 45 patients did not have HT. Patients with HT had increased odds of microcalcifications (odds ratio [OR]: 3.01, P = .031) and decreased odds of palpable nodules (OR: 0.212, P = .024) and T2 lesions (vs. T1) (OR: 0.261, P = .015) compared with non-HT. No significant differences in demographics and the incidence of multifocality, extrathyroidal extension, lymphovascular invasion, lymph node or pulmonary metastases, disease recurrence, or radioactive iodine treatment were found between the two groups. Thyroglobulin/thyroid peroxidase autoantibodies and surgical pathology indicative of HT were concordant in 82.4% (κ = 0.635, P < .001). CONCLUSION HT was present in 50% of children with DTC. Patients with DTC and HT presented with smaller tumors compared to non-HT patients. No significant differences in other markers of disease aggressiveness were found between the two groups. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Richard M Yeker
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Amber D Shaffer
- Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Pushpa Viswanathan
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Selma F Witchel
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Kevin Mollen
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Linwah Yip
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Sara E Monaco
- Department of Pathology, UPMC Shadyside Hospital & Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Umamaheswar Duvvuri
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Jeffrey P Simons
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.,Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
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16
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Lee YJ, Cho YJ, Heo YJ, Chung EJ, Choi YH, Kim JI, Park YJ, Shin CH, Lee YA. Thyroid nodules in childhood-onset Hashimoto's thyroiditis: Frequency, risk factors, follow-up course and genetic alterations of thyroid cancer. Clin Endocrinol (Oxf) 2021; 95:638-648. [PMID: 33894068 DOI: 10.1111/cen.14490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/28/2021] [Accepted: 04/07/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE We evaluated the frequency, risk factors and the follow-up outcomes of thyroid nodules, and genetic alterations in thyroid cancer, in youth with childhood-onset Hashimoto thyroiditis (HT) residing in an iodine-sufficient country. DESIGN A retrospective cohort study. PATIENTS AND MEASUREMENTS A total of 213 patients (194 females, mean age 10.6 years at the time of HT diagnosis) were ultrasonographically evaluated. Thyroid nodules were categorized using the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and the American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TI-RADS). RESULTS Thyroid nodules were detected in 40 (18.8%) patients over a median follow-up period of 3.4 years, usually after the onset of puberty. A family history of thyroid disease (hazard ratio 2.1, p = .031) was predictive of thyroid nodule detection. Papillary thyroid carcinoma (PTC) was diagnosed in 9 (4.2% of all and 22.5% of nodule-positive patients). The malignant nodules had a higher K-TIRADS or ACR-TI-RADS risk level compared with benign nodules (p < .01 for both). Genetic alterations were revealed in 7 (BRAFV600E in 6 and RET-ERC1 fusion in 1) of the eight available tumour tissue samples. None showed evidence of disease over a median follow-up period of 3.4 years. CONCLUSIONS The nodule detection rate was 18.8%, with a 22.5% risk of malignancy among the detected nodules in childhood-onset HT patients, showing increased risk in those with a family history. Additional large-scale studies are required to evaluate the usefulness of K-TIRADS or ACR-TI-RADS risk level for the differentiation of paediatric thyroid nodules.
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Affiliation(s)
- Yun Jeong Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea
| | - Yeon Jin Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - You Joung Heo
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jong-Il Kim
- Medical Research Center, Genomic Medicine Institute, Seoul National University, Seoul, Korea
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea
- Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Young Joo Park
- Medical Research Center, Genomic Medicine Institute, Seoul National University, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea
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Elmaoğulları S, Özalkak Ş, Çetinkaya S, Karaman İ, Üner Ç, Arda N, Savaş-Erdeve Ş, Aycan Z. Evaluation of Children and Adolescents with Thyroid Nodules: A Single Center Experience. J Clin Res Pediatr Endocrinol 2021; 13:276-284. [PMID: 33374093 PMCID: PMC8388051 DOI: 10.4274/jcrpe.galenos.2020.2020.0213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the clinical, radiological and pathological findings of children and adolescents with thyroid nodules. METHODS Data of 121 children and adolescent with thyroid nodules and had fine needle aspiration (FNA) were examined retrospectively. Concomitant thyroid disease, ultrasonography (US) features of the nodule, FNA and histopathological results were recorded. FNA results were assessed according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). RESULTS Median (range) age of the cases was 14 (3-18) years and 81% were female. FNA results of patients were: insufficient in 1 (0.8%); benign in 68 (56.2%); indeterminate in 44 (36.4%); and malignant in 8 (6.6%) patients. Among 39 patients who underwent surgery, 10 (25.6%) had differentiated thyroid cancer (DTC) and the overall malignancy rate was 10.0% (10/100). Follow-up FNA results showed progress based on TBSRTC in 18.7% of benign results and 4/75 patients had DTC on surgical excision. Two of 22 patients with atypia of undetermined significance (AUS) who continued follow-up was diagnosed with DTC. Male gender, presence of Hashimoto thyroiditis and US findings of uninodularity, hypoechogenicity, increased blood flow, irregular margins, solid structure, microcalcification and presence of abnormal cervical lymph nodes were associated with malignancy. CONCLUSION In this study 10% of thyroid nodules were malignant in children and adolescents. Patients with AUS have a 9% potential for malignancy. Patients with initially benign FNA result may have changes on repeat FNA when assessed with TBSTRC indicating a 5.3% false negative rate.
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Affiliation(s)
- Selin Elmaoğulları
- University of Health Sciences Turkey, Ankara Dr. Sami Ulus Children’s Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey,* Address for Correspondence: University of Health Sciences Turkey, Ankara Dr. Sami Ulus Children’s Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey Phone: +90 532 580 88 62 E-mail:
| | - Şervan Özalkak
- University of Health Sciences Turkey, Ankara Dr. Sami Ulus Children’s Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Semra Çetinkaya
- University of Health Sciences Turkey, Ankara Dr. Sami Ulus Children’s Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - İbrahim Karaman
- University of Health Sciences Turkey, Ankara Dr. Sami Ulus Children’s Training and Research Hospital, Clinic of Pediatric Surgery, Ankara, Turkey
| | - Çiğdem Üner
- University of Health Sciences Turkey, Ankara Dr. Sami Ulus Children’s Training and Research Hospital, Clinic of Pediatric Radiology, Ankara, Turkey
| | - Nilüfer Arda
- University of Health Sciences Turkey, Ankara Dr. Sami Ulus Children’s Training and Research Hospital, Clinic of Pediatric Pathology, Ankara, Turkey
| | - Şenay Savaş-Erdeve
- University of Health Sciences Turkey, Ankara Dr. Sami Ulus Children’s Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Zehra Aycan
- University of Health Sciences Turkey, Ankara Dr. Sami Ulus Children’s Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey,Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
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Development and validation of a population-based model for predicting the regional lymph node metastasis in adolescent differentiated thyroid carcinoma. Oral Oncol 2021; 121:105507. [PMID: 34450454 DOI: 10.1016/j.oraloncology.2021.105507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adolescent differentiated thyroid carcinoma (DTC) is a rare type of thyroid cancer that represents a special entity of all endocrine-related cancer. This study aims to establish the first nomogram for predicting the regional (central and lateral) lymph node metastasis (LNM) in the adolescent population for better surgical management. METHOD We retrospectively reviewed the clinicopathology characteristics of adolescent patients with DTC in the Surveillance, Epidemiology, and End Results database between 2010 and 2015. RESULTS A total of 1,930 adolescent patients between the ages of 10 and 24 years from the SEER database were enrolled in this study. Six predictive factors including age, race, histology, multifocality, extrathyroidal invasion (EI) and tumor size were identified to be significantly associated with the regional LNM via univariate and multivariate logistic regression analyses. These indicators were used to construct a nomogram for predicting the regional LNM in adolescent patients with DTC. Moreover, a satisfied predictive ability of the model was determined with a C-index of 0.794, supported by an internal validation group with a C-index of 0.776. The Decision Curve Analysis and calibration curve further conducted a great agreement in our model. CONCLUSION The first predictive model containing multiple factors has been successfully established with good discrimination for predicting the regional LNM in adolescent patients with DTC. This nomogram could effectively help surgeons to make better individualized surgical decision intraoperatively, especially in terms of whether cervical lymph node dissection (LND) is warranted.
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Loizou L, Demetriou A, Erdman F, Borkhardt A, Brozou T, Sharp L, McNally R. Increasing incidence and survival of paediatric and adolescent thyroid cancer in Cyprus 1998-2017: A population-based study from the Cyprus Pediatric Oncology Registry. Cancer Epidemiol 2021; 74:101979. [PMID: 34247065 DOI: 10.1016/j.canep.2021.101979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/08/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Paediatric and adolescent thyroid cancer incidence rates are increasing in many countries. We determined incidence rates, temporal trends and survival from thyroid cancer diagnosed in childhood and adolescence in Cyprus during 1998-2017. METHODS Patients aged 0-19 years, diagnosed with thyroid cancer in the Pediatric Oncology Registry of Cyprus were included. Crude incidence rates, age standardized rates, time trends and overall survival were analysed. Annual rates and temporal trends were calculated using Microsoft Excel 2016 and Joinpoint regression analysis. RESULTS Eighty-one cases (76.5 % female, 23.5 % male) were identified. The crude rates (per 100,000 persons) were for both sexes 2.00 (95 % CI 1.61, 2.49), females 3.15 (95 % CI 2.45, 4.03) and males 0.92 (95 % CI 0.58, 1.44). The annual percentage changes of crude and standardised rates were 7.5 % (p < 0.05) and 7.6 % (p < 0.05). The annual percentage changes of crude rates were for females 5.1 % (p = 0.1), males 8.4 % (p < 0.05) and 15-19-year-olds 7.6 % (p < 0.05). The female to male rate ratio was 3.42 (95 % CI 2.06, 5.74). Papillary thyroid carcinoma represented 86.4 % of all cases. There was only one case after previous cancer therapy. The rate ratio of 2nd (2008-2017) to 1st (1998-2007) periods for metastatic (regional) stages was 3.76 (95 % CI 1.74, 8.31). Survival until 2018 was 100 %. CONCLUSION This population-based study demonstrated that thyroid cancer incidence rates in 0-19-year-olds in Cyprus was among the world's highest. Increasing trends mainly affected males and females aged 15-19 years with papillary thyroid carcinoma, the dominant type. Cases after previous cancer therapy didn't contribute to increasing rates. The increase of metastatic cases suggests a true increase of thyroid cancer rather than overdiagnosis. Although prognosis is excellent with 100 % survival, the rising incidence rate is unexplained, indicating the need to identify causes.
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Affiliation(s)
- Loizos Loizou
- Pediatric Oncology/Hematology Clinic, Archbishop Makarios III Hospital Nicosia and University of Nicosia Medical School, Cyprus; Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK.
| | - Anna Demetriou
- National Cancer Registry, Health Monitoring Unit, Ministry of Health, Cyprus.
| | - Friederike Erdman
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
| | - Arndt Borkhardt
- Department of Paediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Heinrich-Heine University Dusseldorf, Dusseldorf, Germany.
| | - Triantafyllia Brozou
- Department of Paediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Heinrich-Heine University Dusseldorf, Dusseldorf, Germany.
| | - Linda Sharp
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK.
| | - Richard McNally
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK.
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20
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Sur ML, Gaga R, Lazăr C, Lazea C, Aldea C, Sur D. Papillary thyroid carcinoma in children with Hashimoto's thyroiditis - a review of the literature between 2000 and 2020. J Pediatr Endocrinol Metab 2020; 33:1511-1517. [PMID: 33180046 DOI: 10.1515/jpem-2020-0383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/22/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Thyroid cancer is the most common pediatric endocrine neoplasm representing 3% of all malignancies in children. Hashimoto's thyroiditis (HT) is also a common disorder in the pediatric age range. Patients with HT frequently develop enlarged thyroid with nodules. We aimed to provide a literature review on the frequency of papillary thyroid carcinoma (PTC) in patients with HT. CONTENT A literature search of the PubMed database between 2000 and 2020 was performed, using the relevant keywords "papillary thyroid carcinoma," "Hashimoto's thyroiditis" and "children". We followed the PRISMA statement guidelines during the preparation of this review. Six studies (n=2,065 patients with HT) were retained for the final analysis. The follow-up of the patients with HT was from 2 to 10 years. PTC was diagnosed in 0.67-7.87% of the HT patients included in these studies. In patients with HT and nodules, the percentage of PTC varied between 5.13 and 35%. The overall occurrence of PTC in patients with HT was 3.07%. SUMMARY AND OUTLOOK The number of patients developing thyroid nodules in relation to HT was increased. The development of PTC in children with HT appeared to be higher than in the normal population.
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Affiliation(s)
- Maria Lucia Sur
- Department of Pediatrics, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Remus Gaga
- Department of Pediatrics, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Călin Lazăr
- Department of Pediatrics, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Cecilia Lazea
- Department of Pediatrics, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Cornel Aldea
- Department of Pediatrics, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Daniel Sur
- Department of Medical Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,The Oncology Institute "Prof. Dr. Ion Chiricuta", Cluj-Napoca, Romania
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21
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Fadlalbari GF, Mukhwana RO, Abdullah MA. Autoimmune hyperthyroidism in children & adolescents in Sudan: a 13 years' experience of a Paediatric Endocrinology Clinic. J Pediatr Endocrinol Metab 2020; 33:879-884. [PMID: 32658864 DOI: 10.1515/jpem-2020-0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/26/2020] [Indexed: 11/15/2022]
Abstract
Background Little has been published about hyperthyroidism in children from Sudan or Africa. In limited resource countries, lack of facilities and sociocultural factors might make international diagnosis and management guidelines difficult to follow. We aimed to determine the magnitude of autoimmune hyperthyroidism, clinical presentation, diagnosis, management and its outcome in Sudan. Method Records of all patients diagnosed as Graves' disease (GD) or Hashitoxicosis (HTx) were reviewed and missing data filled by interviewing patients and/or their families. Data including age, sex, clinical presentation, investigations, management and outcome were obtained. Results Eighty-eight patients, 80 with GD (F:M = 4.7:1) and 8 with HTx (F:M = 7:1), were diagnosed at 11.8 ± 3.05 and 11.23 ± 2.78 years, respectively (p = 0.52). GD patients were diagnosed based on presence of exophthalmos (66.25%), positive thyroid receptor autoantibodies (12.5%), prolonged illness duration (8.75%) or remission failure to only B blocker (16.25%). All GD patients were started on carbimazole and cumulative remission rate was 11.8%, 32.4% and 41.2% by end of the second, third and fourth year respectively, however it plateaus after that. While 12 GD patients underwent surgery, only three opted for radioiodine ablation. Conclusion Hyperthyroidism is not an uncommon problem. In absence of laboratory facilities, differentiation between GD and HTx can be made based on clinical grounds. Continuation of medical treatment for 4 years can increase the remission rate to 41.2%. In Sudan, surgery is the preferred method of definitive therapy.
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Affiliation(s)
- Ghassan Faisal Fadlalbari
- Paediatric Endocrinology and Diabetes Unit, Gafar Ibn Auf Specialized Children Hospital, Khartoum, Sudan
| | - Renson O Mukhwana
- Department of Paediatric Endocrinology and Diabetes, Gertrude Garden Children Hospital, Nairobi, Kenya
| | - Mohamed Ahmed Abdullah
- Department of Paediatrics and Child Health, Faculty of Medicine, University of Khartoum, Sudan and Endocrinology Unit, Gafar Ibn Auf Specialized Children Hospital, Khartoum, Sudan
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Allen N, Desai N, Song C, Yu J, Prasad U, Francis G. Clinical features may help to identify children and adolescents with greatest risk for thyroid nodules. J Endocrinol Invest 2020; 43:925-934. [PMID: 31927747 DOI: 10.1007/s40618-019-01176-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 12/25/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Thyroid nodules (TN) are detected in a small number of asymptomatic children and adolescents but are more frequently malignant (22-26%) than in adults leading some clinicians to perform thyroid ultrasound (US) for all children with goiter or autoimmune thyroiditis (AIT). Our study was designed to determine if suspicious clinical features predict the presence of TN in children with goiter or AIT so that US could be performed on those at highest risk. METHODS This was a retrospective review of 223 children and adolescents with goiter or AIT evaluated at a single institution. US was not performed on all patients. It is our practice to define glands that are large, firm, or nodular to palpation as "suspicious". Suspicious glands were interrogated by US and if TN was confirmed, this was further evaluated by fine-needle aspiration followed by surgery if indicated. RESULTS The median age was 12.9 years with 74.4% female. TN were confirmed by US in 16.6% of all patients but only 4.8% of those with AIT. By univariate analysis, TN were more common in those with family history of TN or differentiated thyroid carcinoma (DTC), thyroid asymmetry, and lower thyrotropin (TSH) levels. Differentiated thyroid carcinoma (DTC) was identified in 10.8% of TN and 1.8% of all patients. Firmness was significantly more common in patients with DTC (p = 0.0013). CONCLUSION TN were less common in those with AIT than reported in previous studies, suggesting that clinical features might fail to identify the majority of TN in patients with AIT. However, patients with asymmetric thyroid and a family history of TN or DTC have greatest risk for TN.
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Affiliation(s)
- N Allen
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA
| | - N Desai
- Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA
| | - C Song
- Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA
| | - J Yu
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - U Prasad
- Department of Radiology, Virginia Commonwealth University, Richmond, VA, USA
| | - G Francis
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Texas Health Science Center at San Antonio, 7301 Floyd Curl Drive, San Antonio, TX, 78229, USA.
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23
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Januś D, Kalicka-Kasperczyk A, Wójcik M, Drabik G, Starzyk JB. Long-term ultrasound follow-up of intrathyroidal ectopic thymus in children. J Endocrinol Invest 2020; 43:841-852. [PMID: 31902058 DOI: 10.1007/s40618-019-01172-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/21/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To present the sonographic follow-up of intrathyroidal ectopic thymus (IET) in children and adolescent patients. PATIENTS Out of the 507 children referred to FNAB between 2006 and 2018, 30 (5.9%) pediatric patients (10 females), mean age 5.7 years (1.2-13.8, median 4.9 years) were diagnosed with IET. METHODS A retrospective analysis of medical files of patients diagnosed with IET between 2006 and 2018. Assessed data included ultrasound characterisation, elastographic strain ratio (SR) results and hormonal evaluation. RESULTS Analysis of thyroid US scans revealed that the mean age at the first thyroid ultrasound was 5.7 (1.2-13.8, median 4.9) years, and at the last US 10.7 (3.7-18, median 10.5) years. The mean time of the IET observation was 59.6 (2-148, median 53.5) months. On US, IET was hypoechoic with multiple linear and punctate echoes, hypovascular, fusiform on longitudinal plane and round or polygonal on an axial plane, more common in the right thyroid lobe (66.7%) and located in the posterior part of the lobes (54.5%), bilateral in two patients and multifocal in one patient. SR of IET was similar to the surrounding normal thyroid tissue. Complete regression of IET was observed in 12/30 patients after a mean time of 81.7 months (median 76.5), at the mean age of 13.7 (9.2-18, median 13.9) years. FNAB was performed in 10/30 and a hemithyroidectomy in 1/30 IET patients. In the FNAB (+) group, patients were younger (5.08 vs 6.08 years) and lesions were larger (0.12 ml vs 0.05 ml) than in the FNAB (-) group. All patients with IET were euthyroid with negative TPOAb and TgAb levels. CONCLUSION The reproducibility of unique ultrasound features of IETs allows for safe long-term follow-up of these benign lesions in the majority of pediatric patients: not only monitoring the regression of IET but also screening towards the rare occurrence of a tumor arising from the IET.
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Affiliation(s)
- D Januś
- Department of Paediatric and Adolescent Endocrinology, Chair of Paediatrics, Institute of Paediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Kraków, Poland.
- Department of Paediatric and Adolescent Endocrinology, University Children's Hospital, Kraków, Poland.
| | - A Kalicka-Kasperczyk
- Department of Paediatric and Adolescent Endocrinology, Chair of Paediatrics, Institute of Paediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Kraków, Poland
- Department of Paediatric and Adolescent Endocrinology, University Children's Hospital, Kraków, Poland
| | - M Wójcik
- Department of Paediatric and Adolescent Endocrinology, Chair of Paediatrics, Institute of Paediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Kraków, Poland
- Department of Paediatric and Adolescent Endocrinology, University Children's Hospital, Kraków, Poland
| | - G Drabik
- Department of Clinical Immunology and Transplantation, Institute of Paediatrics, Jagiellonian University Medical College, Kraków, Poland
| | - J B Starzyk
- Department of Paediatric and Adolescent Endocrinology, Chair of Paediatrics, Institute of Paediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Kraków, Poland
- Department of Paediatric and Adolescent Endocrinology, University Children's Hospital, Kraków, Poland
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Geurts JL, Strong EA, Wang TS, Evans DB, Clarke CN. Screening guidelines and recommendations for patients at high risk of developing endocrine cancers. J Surg Oncol 2020; 121:975-983. [DOI: 10.1002/jso.25869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 02/09/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Jennifer L. Geurts
- Graduate School of Biomedical SciencesMedical College of WisconsinMilwaukee Wisconsin
| | - Erin A. Strong
- Division of Surgical Oncology, Department of SurgeryMedical College of WisconsinMilwaukee Wisconsin
| | - Tracy S. Wang
- Division of Surgical Oncology, Department of SurgeryMedical College of WisconsinMilwaukee Wisconsin
| | - Douglas B. Evans
- Division of Surgical Oncology, Department of SurgeryMedical College of WisconsinMilwaukee Wisconsin
| | - Callisia N. Clarke
- Division of Surgical Oncology, Department of SurgeryMedical College of WisconsinMilwaukee Wisconsin
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25
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Paulson VA, Rudzinski ER, Hawkins DS. Thyroid Cancer in the Pediatric Population. Genes (Basel) 2019; 10:genes10090723. [PMID: 31540418 PMCID: PMC6771006 DOI: 10.3390/genes10090723] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 12/26/2022] Open
Abstract
Thyroid cancer is rare in the pediatric population, but thyroid carcinomas occurring in children carry a unique set of clinical, pathologic, and molecular characteristics. In comparison to adults, children more often present with aggressive, advanced stage disease. This is at least in part due to the underlying biologic and molecular differences between pediatric and adult thyroid cancer. Specifically, papillary thyroid carcinoma (which accounts for approximately 90% of pediatric thyroid cancer) has a high rate of gene fusions which influence the histologic subtypes encountered in pediatric thyroid tumors, are associated with more extensive extrathyroidal disease, and offer unique options for targeted medical therapies. Differences are also seen in pediatric follicular thyroid cancer, although there are few studies of non-papillary pediatric thyroid tumors published in the literature due to their rarity, and in medullary carcinoma, which is most frequently diagnosed in the pediatric population in the setting of prophylactic thyroidectomies for known multiple endocrine neoplasia syndromes. The overall shift in the spectrum of histotypes and underlying molecular alterations common in pediatric thyroid cancer is important to recognize as it may directly influence diagnostic test selection and therapeutic recommendations.
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Affiliation(s)
- Vera A Paulson
- Dept. of Laboratory Medicine, University of Washington Medical Center, 1959 NE Pacific St, Box 357110, Seattle, WA 98105, USA.
| | - Erin R Rudzinski
- Dept. of Laboratories, Seattle Children's Hospital, OC.8.720; 4800 Sandpoint Way NE, Seattle, WA 98105, USA.
| | - Douglas S Hawkins
- University of Washington Medical Center, Fred Hutchinson Cancer Research Center and Cancer and Blood Disorders Center, Seattle Children's Hospital, MB.8.501, Seattle, WA 98105, USA.
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26
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Zirilli G, Salzano G, Corica D, Pajno GB, Mignosa C, Pepe G, De Luca F, Crisafulli G. Thyrotropin serum levels and coexistence with Hashimoto's thyroiditis as predictors of malignancy in children with thyroid nodules. Ital J Pediatr 2019; 45:96. [PMID: 31387613 PMCID: PMC6685280 DOI: 10.1186/s13052-019-0693-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/30/2019] [Indexed: 12/21/2022] Open
Abstract
Thyroid cancer (TC) in childhood is a rare disease characterized by an excellent prognosis. Thyroid nodules in children, although less common than in adults, have a greater risk of malignancies, particularly in those cases associated with anamnestic, clinical and ultrasonographic risk factors. Among the factors, which have been found to be linked with an increased relative risk of TC in children, an important role seems to be possibly played by an underlying nodular Hashimoto’s thyroiditis (HT) and by the serum levels of TSH. Aim of this Commentary was to specifically address this last point. According to the available pediatric literature on the relationships between these risk factors and phenotypical expression of TC in children, it is possible to conclude that: 1) It is not completely clarified if HT per se predisposes to malignancy or if it represents an incidental histologic finding in cases with TC or if it may be the result of an immune response against tumoral cells. 2) It is unclear whether phenotypic expression of TC is more severe in the cases with associated HT but normal TSH serum levels. 3) Persistently elevated TSH levels play an independent role as predictors of the likelihood of TC, especially in children but also in adults. 4) Patients with nodular HT and subclinical hypothyroidism need to be treated with Levothyroxine in order to prevent the development of both TC and severe thyroid dysfunctions.
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Affiliation(s)
- Giuseppina Zirilli
- Department of Human Pathology of Adulthood and Childhood Unit of Pediatrics, University of Messina, Messina, Italy
| | - Giuseppina Salzano
- Department of Human Pathology of Adulthood and Childhood Unit of Pediatrics, University of Messina, Messina, Italy
| | - Domenico Corica
- Department of Human Pathology of Adulthood and Childhood Unit of Pediatrics, University of Messina, Messina, Italy.
| | - Giovanni Battista Pajno
- Department of Human Pathology of Adulthood and Childhood Unit of Pediatrics, University of Messina, Messina, Italy
| | - Cristina Mignosa
- Department of Human Pathology of Adulthood and Childhood Unit of Pediatrics, University of Messina, Messina, Italy
| | - Giorgia Pepe
- Department of Human Pathology of Adulthood and Childhood Unit of Pediatrics, University of Messina, Messina, Italy
| | - Filippo De Luca
- Department of Human Pathology of Adulthood and Childhood Unit of Pediatrics, University of Messina, Messina, Italy
| | - Giuseppe Crisafulli
- Department of Human Pathology of Adulthood and Childhood Unit of Pediatrics, University of Messina, Messina, Italy
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27
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Januś D, Wójcik M, Taczanowska A, Sołtysiak P, Wędrychowicz A, Roztoczyńska D, Drabik G, Wyrobek Ł, Starzyk JB. Follow-up of parenchymal changes in the thyroid gland with diffuse autoimmune thyroiditis in children prior to the development of papillary thyroid carcinoma. J Endocrinol Invest 2019; 42:261-270. [PMID: 29872995 PMCID: PMC6394764 DOI: 10.1007/s40618-018-0909-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 05/30/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE To present the outcomes of ultrasound (US) follow-ups in children with autoimmune thyroid disease who did not have a thyroid nodule on admission but developed papillary thyroid carcinoma (PTC) and to characterize the parenchymal changes in the thyroid gland prior to the development of PTC. METHODS A retrospective thyroid US scan review of 327 patients diagnosed with AIT was performed. Forty patients (40/327, 12.2%) presented nodular AIT variant with a normoechogenic background. Eleven patients (11/327, 3.4%, 11/40, 27.5%) presenting this variant were diagnosed with PTC (nine females-mean age 15.3 years; two males aged 11 and 13 years). In five of 11 patients, the suspicious nodule that was later confirmed to be PTC was detected on the initial US at presentation. For the remaining six females (6/11) who developed PTC during the follow-up, we retrospectively analysed their US thyroid scans and these patients were selected for analysis in this study. RESULTS On admission, the US evaluation revealed an enlarged normoechogenic thyroid gland in three patients and a hypoechogenic thyroid gland with fibrosis as indicated by irregular, chaotic hyperechogenic layers in three patients. No thyroid nodules were identified. Ultrasound monitoring revealed increasing echogenicity of the thyroid parenchyma during the follow-up. PTC developed in a mean time of 4.6 years (1 9/12-7 4/12 years) since referral to the outpatient thyroid clinic and 2.9 years (6/12-6 9/12) since the last nodule-free US thyroid scan. CONCLUSIONS Sonographic follow-up assessments warrant further exploration as a strategy to determine PTC susceptibility in the paediatric population.
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Affiliation(s)
- D Januś
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Krakow, Poland.
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland.
| | - M Wójcik
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland
| | - A Taczanowska
- Department of Pediatric Surgery, University Children Hospital, Krakow, Poland
- Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - P Sołtysiak
- Department of Pediatric Surgery, University Children Hospital, Krakow, Poland
- Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - A Wędrychowicz
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland
| | - D Roztoczyńska
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland
| | - G Drabik
- Department of Clinical Immunology and Transplantation, Institute of Paediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Ł Wyrobek
- Department of Radiology, University Children Hospital, Krakow, Poland
| | - J B Starzyk
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland
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Radetti G, Loche S, D'Antonio V, Salerno M, Guzzetti C, Aversa T, Cassio A, Cappa M, Gastaldi R, Deluca F, Vigone MC, Tronconi GM, Corrias A. Influence of Hashimoto Thyroiditis on the Development of Thyroid Nodules and Cancer in Children and Adolescents. J Endocr Soc 2019; 3:607-616. [PMID: 30820486 PMCID: PMC6389351 DOI: 10.1210/js.2018-00287] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 12/28/2018] [Indexed: 11/19/2022] Open
Abstract
It is unclear whether patients with Hashimoto thyroiditis (HT) are predisposed to develop thyroid nodules and/or thyroid cancer. The objective of our study was therefore to assess the prevalence of thyroid nodules and/or cancer in patients with HT and to look for possible prognostic factors. A retrospective survey of 904 children/adolescents with HT (709 females, 195 males) regularly followed in nine Italian centers of pediatric endocrinology was performed. Median period of follow-up was 4.5 years (1.2 to 12.8 years). We evaluated free T4, TSH, thyroid peroxidase antibody (TPOAb), thyroglobulin antibodies, and thyroid ultrasound yearly. One hundred seventy-four nodules were detected, with an annual incidence rate of 3.5%. Ten nodules were malignant (8 papillary and 2 papillary follicular variant), giving a 5.7% prevalence of cancer among patients with nodules. The severity of hypoechogenity at ultrasound, TPOAb, and free T4 serum concentrations were predictive for the appearance of new nodules. Furthermore, a positive correlation was observed between TPOAb titer and the development of thyroid cancer. In conclusion, HT seems to influence the development of thyroid nodules, but not cancer in children and adolescents.
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Affiliation(s)
| | - Sandro Loche
- Ospedale Pediatrico Microcitemico, A. Cao, Cagliari, Italy
| | | | | | | | - Tommaso Aversa
- Department of Pediatrics, University of Messina, Messina, Italy
| | | | - Marco Cappa
- Department of Pediatric Endocrinology, Bambino Gesù Children Hospital, Roma, Italy
| | | | - Filippo Deluca
- Department of Pediatrics, University of Messina, Messina, Italy
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Creo A, Alahdab F, Al Nofal A, Thomas K, Kolbe A, Pittock S. Diagnostic accuracy of the McGill thyroid nodule score in paediatric patients. Clin Endocrinol (Oxf) 2019; 90:200-207. [PMID: 30326152 DOI: 10.1111/cen.13878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/11/2018] [Accepted: 10/11/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Thyroid cancer is the most common paediatric endocrine cancer; accurate diagnosis and prompt management of paediatric thyroid nodules is critical. The McGill Thyroid Nodule Score (MTNS), based upon clinical, ultrasound (US) and cytology criteria, has recently been modified and studied in a pilot paediatric group with good results. We aim to describe the diagnostic accuracy of the paediatric modified MTNS (PMTNS) in a large paediatric cohort. METHODS We utilized an established retrospective cohort between 1996 and 2015 of 99 patients ≤21 years old with 131 thyroid nodules. Two experienced paediatric radiologists, blinded to pathology and radiology reports, reviewed US features. We abstracted cytology, histology and laboratory results, assigning each nodule a PMTNS. PMTNS performance was compared to FNA and histology. RESULTS Approximately 33% of nodules were malignant. The cohort was predominantly adolescent (mean age 15.4 ± 3.8 years). The average PMTNS for malignant and benign nodules, based on final histology, was 12.7 ± 4.3 and 1.7 ± 2.9, respectively. A PMTNS ≥8 resulted in a 93.2% sensitivity and 93.1% specificity for detecting malignancy, while a PMTNS ≥9 resulted in a 90.9% sensitivity and 96.6% specificity. However, Bethesda cytology category ≥4 independently had a 97.7% sensitivity and 94.0% specificity for detecting malignancy. The PMTNS had diminishing diagnostic accuracy in younger children compared with older children. CONCLUSION Paediatric modified McGill Thyroid Nodule Score predicts malignancy, perhaps due to the score's emphasis on cytology results; however, the score is less accurate in younger patients. While cytology results remain reliable, further work is needed to develop a non-invasive scoring system to predict malignancy in children.
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Affiliation(s)
- Ana Creo
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota
| | - Fares Alahdab
- Division of Preventative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Alaa Al Nofal
- Division of Pediatric Endocrinology, Sioux Falls, South Dakota
| | - Kristen Thomas
- Division of Pediatric Radiology, Mayo Clinic, Rochester, Minnesota
| | - Amy Kolbe
- Division of Pediatric Radiology, Mayo Clinic, Rochester, Minnesota
| | - Siobhan Pittock
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota
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Crisafulli G, Aversa T, Zirilli G, Pajno GB, Corica D, De Luca F, Wasniewska M. Subclinical Hypothyroidism in Children: When a Replacement Hormonal Treatment Might Be Advisable. Front Endocrinol (Lausanne) 2019; 10:109. [PMID: 30858827 PMCID: PMC6397829 DOI: 10.3389/fendo.2019.00109] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 02/06/2019] [Indexed: 01/07/2023] Open
Abstract
Aim of this mini review was to analyze the main variables which should be taken into account when the decision regarding a possible treatment with L-T4 has to be considered for a child with subclinical hypothyroidism (SH). The indications of periodical monitoring and vigilance have been also discussed. It was inferred that therapy should be recommended for children with underlying Hashimoto's thyroiditis and progressive deterioration of thyroid status over time, particularly in the cases with goiter and hypothyroid symptoms and in those with associated Turner syndrome or Down's syndrome and/or other autoimmune diseases. Treatment might also be recommended for children with proatherogenic metabolic abnormalities. Treatment is not advisable in children with idiopathic and mild SH, no goiter, no hypothyroid symptoms and negative anti-thyroid autoantibodies. In the absence of any therapeutic intervention, clinical status and thyroid function tests should be periodically monitored, in order to individuate the children who might benefit from treatment. It has been suggested that children with a persistent mild elevation of TSH, who are not treated with L-T4, should undergo biochemical monitoring of thyroid function and re-assessment of clinical status every 6 months. After 2 years with stable thyroid function tests, the interval between monitoring can be extended.
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Ogle S, Merz A, Parina R, Alsayed M, Milas M. Ultrasound and the Evaluation of Pediatric Thyroid Malignancy: Current Recommendations for Diagnosis and Follow-up. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2311-2324. [PMID: 29575028 DOI: 10.1002/jum.14593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/21/2017] [Accepted: 12/27/2017] [Indexed: 06/08/2023]
Abstract
Ultrasound (US) plays a critical role in the evaluation, treatment, screening, and surveillance of thyroid malignancy in pediatric patients. This review aims to summarize recent advances in this topic. Improvements in imaging technology have amplified the advantage of US and US-guided fine-needle aspiration biopsy for thyroid nodule evaluation, cancer diagnosis, and surgical planning. Ultrasound has a definitive screening role for early cancer detection in high-risk patients, including those with a history of radiation exposure from childhood treatments, environmental radiation disasters, or hereditary/familial cancer syndromes. Finally, US is a key component of lifelong surveillance for recurrence among pediatric thyroid cancer survivors.
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Affiliation(s)
- Sarah Ogle
- Endocrine Surgery Center, Diabetes and Endocrinology Institute, Department of Surgery, University of Arizona, Phoenix School of Medicine, Banner University Medical Center, Phoenix, Arizona, USA
| | - Alexa Merz
- Endocrine Surgery Center, Diabetes and Endocrinology Institute, Department of Surgery, University of Arizona, Phoenix School of Medicine, Banner University Medical Center, Phoenix, Arizona, USA
| | - Ralitza Parina
- Endocrine Surgery Center, Diabetes and Endocrinology Institute, Department of Surgery, University of Arizona, Phoenix School of Medicine, Banner University Medical Center, Phoenix, Arizona, USA
| | - Mahmoud Alsayed
- Department of Endocrinology, Banner University Medical Center, Phoenix, Arizona, USA
| | - Mira Milas
- Endocrine Surgery Center, Diabetes and Endocrinology Institute, Department of Surgery, University of Arizona, Phoenix School of Medicine, Banner University Medical Center, Phoenix, Arizona, USA
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Won JH, Lee JY, Hong HS, Jeong SH. Thyroid nodules and cancer in children and adolescents affected by Hashimoto's thyroiditis. Br J Radiol 2018; 91:20180014. [PMID: 29595320 PMCID: PMC6221765 DOI: 10.1259/bjr.20180014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/13/2018] [Accepted: 03/28/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To investigate the rates of thyroid nodules and cancer in pediatric cases of Hashimoto's thyroiditis (HT) in Korea. METHODS We retrospectively reviewed 89 pediatric and adolescent patients (age, 3-18.0 years) with HT who underwent thyroid ultrasonography (US) at our institution from February 2006 to July 2016. The diagnosis of HT was based on the presence of thyroid autoantibodies. The presence of any thyroid nodules with US and cytopathologic features was analyzed. The malignancy rate was also determined. RESULTS Thyroid nodules were in 20 of the 89 patients (22.4%). Eight of these 20 patients (40%) had colloid cysts, two (10%) had nodular hyperplasia, one (5%) had follicular adenoma, and two (10%) had lymphocytic thyroiditis. Seven of the 89 patients (7.9%) were confirmed to have a malignancy, all of which were papillary thyroid carcinoma (PTC); of those, five patients had diffuse sclerosing variant PTC, and two had conventional PTC on pathology. CONCLUSION The prevalence of thyroid nodules in children and adolescents with HT was 22.4%. The malignancy rate of children with HT was 7.9%. The malignancy rate among thyroid nodules was 35%, which is higher than the 26% rate generally reported for children with nodules. Therefore, using thyroid US to survey known or suspected thyroid nodules might be helpful in children and adolescents with HT and may provide further useful diagnostic information. Advances in knowledge: Thyroid US could help to assess HT patients who have known or suspected thyroid nodules.
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Affiliation(s)
- Ji Hye Won
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Ji Ye Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hyun Sook Hong
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sun Hye Jeong
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Januś D, Wójcik M, Drabik G, Wyrobek Ł, Starzyk JB. Ultrasound variants of autoimmune thyroiditis in children and adolescents and their clinical implication in relation to papillary thyroid carcinoma development. J Endocrinol Invest 2018; 41:371-380. [PMID: 28866751 PMCID: PMC5823967 DOI: 10.1007/s40618-017-0758-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/26/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The prevalence of autoimmune thyroiditis (AIT) and papillary thyroid carcinoma (PTC) is rising in children and adolescents, and the coincidence of AIT and PTC is as high as 6.3-43%. OBJECTIVE To investigate the ultrasound manifestation of AIT in relation to PTC development in paediatric patients. PATIENTS 179 paediatric patients (133 females), mean (SD) age: 13.9 (3.03) years diagnosed with AIT and referred for ultrasound evaluation. Eight patients were diagnosed with PTC (6 females). METHODS Retrospective analysis of thyroid ultrasound scans of patients diagnosed with AIT. Thyroid and autoimmune status was assessed based on TSH, fT4, fT3 and increased aTPO and/or aTG and/or TRAB levels. In patients with PTC, total thyroidectomy was performed. RESULTS Analysis of thyroid US scans revealed that the following five ultrasound variants of AIT were observed in 179 patients: the most common in 35.2%-diffuse thyroiditis with hypoechogenic background and normoechogenic parenchyma, in 30.2%-diffuse thyroiditis with irregular background, in 18.9% nodular variant with normoechogenic background, in 11.7%-micronodulations and in 3.9%-diffuse hypoechogenic background. Eight cases of PTC were diagnosed in nodular variant of AIT with normoechogenic irregular background. CONCLUSION Patients with AIT and nodular variant with normoechogenic irregular background of the thyroid gland on US scans are in the risk group of developing PTC and should be followed up with regular neck US assessment.
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Affiliation(s)
- D Januś
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Krakow, Poland.
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland.
| | - M Wójcik
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland
| | - G Drabik
- Department of Clinical Immunology and Transplantation, Institute of Paediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Ł Wyrobek
- Department of Radiology, University Children Hospital, Krakow, Poland
| | - J B Starzyk
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland
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Zirilli G, Cannavò L, Vermiglio F, Violi MA, Luca FD, Wasniewska M. Differentiated thyroid carcinoma presentation may be more aggressive in children and adolescents than in young adults. Ital J Pediatr 2018; 44:13. [PMID: 29343289 PMCID: PMC5772690 DOI: 10.1186/s13052-018-0455-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 01/11/2018] [Indexed: 01/17/2023] Open
Abstract
Background The available studies concerning the influence of age on the phenotypical expression of differentiated thyroid carcinoma (DTC) have hitherto compared DTC presentation either between pre-pubertal and pubertal children or between pediatric patients and aged adults; aim of this study was to ascertain for the first time whether presentation of DTC may significantly vary according to age, even within a peculiar study population covering only young patients aged less than 30 years. Methods The main clinical, biochemical and pathologic data at DTC diagnosis were retrospectively recorded in 2 selected cohorts including, respectively, 18 children and adolescents aged less than 18 years (Group A) or 45 young adults aged between 20 and 29.8 years (Group B). Results The statistical distribution of DTC cases in the different age ranges was found to progressively increase with increasing age; furthermore, the patients of Group A exhibited at diagnosis a more severe clinical involvement and a higher rate of extra-regional metastases; finally, also the association with both autoimmune thyroid diseases (AITDs) and a biochemical hypothyroid pattern was more common in Group A patients. Conclusions In a study population younger than 30 years: a) the risk of developing DTC increases with age, achieving its zenith during the 3rd decade of life; b) clinical presentation is more severe in children and adolescents younger than 18 years than in the patients aged between 20 and 30; c) in the cohort of children and adolescents DTC is more often associated with AITDs, which might play some role in conditioning the more aggressive phenotypical presentation of DTC in this patient group.
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Affiliation(s)
- Giuseppina Zirilli
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - Laura Cannavò
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - Francesco Vermiglio
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maria Antonia Violi
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Filippo De Luca
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy. .,Dipartimento di Patologia Umana dell'adulto e dell'età evolutiva "G. Barresi", AOU "G. Martino", Via Consolare Valeria, 98125, Messina, Italy.
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
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Penta L, Cofini M, Lanciotti L, Leonardi A, Principi N, Esposito S. Hashimoto's Disease and Thyroid Cancer in Children: Are They Associated? Front Endocrinol (Lausanne) 2018; 9:565. [PMID: 30356680 PMCID: PMC6189282 DOI: 10.3389/fendo.2018.00565] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/05/2018] [Indexed: 12/18/2022] Open
Abstract
Hashimoto's thyroiditis (HT) is the most common cause of thyroid disease in children and adolescents. Along with significant modifications of thyroid function, HT in pediatric age can be accompanied by relevant thyroid structural alterations. Over time, benign thyroid nodules, carcinoma and, rarely, primary non-Hodgkin lymphoma can develop. However, the relationships between HT and neoplasms are poorly defined. The main aim of this paper is to discuss what is presently known regarding the coexistence of HT and thyroid tumors. Moreover, we attempt to define the pathogenesis of cancer development in children with HT. Literature analysis showed that despite its rarity and relatively promising prognosis, thyroid cancer is associated with HT. Although not all reasons for the coexistence of these diseases are clearly defined, children with HT should be considered at higher risk for thyroid cancer development. Strict correlations between high levels of serum TSH and anti-thyroid antibodies with cancer must be remembered. The same is true for the presence of nodules, especially if multiple nodules are present and ultrasonography and thyroid fine needle aspiration cytology should be promptly used in uncertain cases.
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Affiliation(s)
- Laura Penta
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università Degli Studi di Perugia, Perugia, Italy
| | - Marta Cofini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università Degli Studi di Perugia, Perugia, Italy
| | - Lucia Lanciotti
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università Degli Studi di Perugia, Perugia, Italy
| | - Alberto Leonardi
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università Degli Studi di Perugia, Perugia, Italy
| | | | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università Degli Studi di Perugia, Perugia, Italy
- *Correspondence: Susanna Esposito
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Xing W, Liu X, He Q, Zhang Z, Jiang Z. BRAF V600E mutation contributes papillary thyroid carcinoma and Hashimoto thyroiditis with resistance to thyroid hormone: A case report and literature review. Oncol Lett 2017; 14:2903-2911. [PMID: 28928829 PMCID: PMC5588167 DOI: 10.3892/ol.2017.6486] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 04/04/2017] [Indexed: 01/17/2023] Open
Abstract
Resistance to thyroid hormone (RTH) is a rare autosomal hereditary disorder characterized by increased serum thyroid hormone (TH) levels with unsuppressed or increased thyrotropin concentration. It remains unknown whether the coexistence of RTH with papillary thyroid carcinoma (PTC) and Hashimoto thyroiditis (HT) is incidental or whether it possesses a genetic or pathophysiological association. In the present study, a case of RTH with PTC and HT in an 11-year-old Chinese patient was examined and the clinical presentation of RTH with PTC was discussed. In addition, the possible associations between RTH, PTC and HT were determined. HT was confirmed in the patient using an autoimmune assay and thyroid ultrasound. RTH was diagnosed on the basis of clinical manifestations, laboratory information and gene analysis, and PTC was diagnosed according to histological results. Results of BRAFV600E mutation analysis were positive. A literature review of 14 cases of RTH with PTC was included for comparison. The present case report indicates an association of RTH with PTC and HT coexistence in the patient. Close follow-up, histological evaluation and BRAFV600E mutation detection should be performed in each RTH case with HT, since a persistent increase in TSH may be a risk factor for the development of thyroid neoplasm.
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Affiliation(s)
- Wanjia Xing
- Department of Endocrinology, General Hospital of Jinan Military Command, Jinan, Shandong 250031, P.R. China
| | - Xiaohong Liu
- Department of Pathology, General Hospital of Jinan Military Command, Jinan, Shandong 250031, P.R. China
| | - Qingqing He
- Department of Thyroid and Breast Surgery, General Hospital of Jinan Military Command, Jinan, Shandong 250031, P.R. China
| | - Zongjing Zhang
- Department of Endocrinology, General Hospital of Jinan Military Command, Jinan, Shandong 250031, P.R. China
| | - Zhaoshun Jiang
- Department of Endocrinology, General Hospital of Jinan Military Command, Jinan, Shandong 250031, P.R. China
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Affiliation(s)
- Christine M Chan
- Section of Endocrinology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Denver, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Jonathan Young
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, University of Colorado Denver, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Jeremy Prager
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, University of Colorado Denver, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Sharon Travers
- Section of Endocrinology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Denver, 13123 East 16th Avenue, Aurora, CO 80045, USA.
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Tronconi E, Miniaci A, Pession A. The autoimmune burden in juvenile idiopathic arthritis. Ital J Pediatr 2017; 43:56. [PMID: 28615030 PMCID: PMC5471888 DOI: 10.1186/s13052-017-0373-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/06/2017] [Indexed: 11/24/2022] Open
Abstract
Background Juvenile idiopathic arthritis (JIA) is a chronic inflammatory arthritis of unknown origin which can be considered an autoimmune disease (AD). The aim of this study is to analyse the presence of two or more autoimmune diseases (polyautoimmunity) in patients suffering from JIA and to evaluate the occurrence of ADs in their families. Methods Seventy-nine patients diagnosed with JIA aged 0–21 years, admitted to the Paediatric Rheumatology Unit, Sant’Orsola-Malpighi Hospital, Bologna were screened for ADs. Parents were asked about the presence of ADs in the living relatives of first and second degree. Results Twelve of 79 patients (15.2%) had at least 1 AD associated with JIA. Eight patients (10.1%) suffered from autoimmune thyroid disease (AITD), three patients had celiac disease, three patients suffered from psoriasis, one from alopecia and 1 from insulin-dependent diabetes mellitus. The average age at diagnosis was 13.2 years and the cumulative incidence of AITD was 36%. Seventy-six families were studied for a total of 438 relatives. The prevalence of ADs was 13%, greater in first-degree relatives (16.7%) than in second-degree ones (11.1%). The most common AD was AITD; there was no difference in JIA’s age of presentation between patients with positive and negative familiarity with ADs (p > 0.05). Conclusion Children and adolescents with JIA present a high autoimmunity burden, most commonly represented by AITD. Familial autoimmunity is not negligible in patients suffering from JIA (almost 50% of patients have at least one relative with an AD) and it should always be carefully examined.
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Affiliation(s)
- Elena Tronconi
- Pediatric Unit, Department of Medical and Surgical Sciences, S. Orsola - Malpighi Hospital, University of Bologna, Bologna, Italy. .,Sant'Orsola-Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy.
| | - Angela Miniaci
- Pediatric Unit, Department of Medical and Surgical Sciences, S. Orsola - Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andrea Pession
- Pediatric Unit, Department of Medical and Surgical Sciences, S. Orsola - Malpighi Hospital, University of Bologna, Bologna, Italy
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Abstract
Nuclear medicine has an important role in the management of many cancers in pediatric age group with multiple imaging modalities and radiopharmaceuticals targeting various biological uptake mechanisms. 18-Flourodeoxyglucose is the radiotracer of choice especially in patients with sarcoma and lymphoma. (18)FDG-PET, for sarcoma and lymphomas, is proved to be superior to conventional imaging in staging and therapy response. Although studies are limited in pediatric population, (18)FDG-PET/CT has found its way through international guidelines. Limitations and strengths of PET imaging must be noticed before adapting PET imaging in clinical protocols. Established new response criteria using multiple parameters derived from (18)FDG-PET would increase the accuracy and repeatability of response evaluation. Current data suggest that I-123 metaiodobenzylguanidine (MIBG) remains the tracer of choice in the evaluation of neuroblastoma (NB) because of its high sensitivity, specificity, diagnostic accuracy, and prognostic value. It is valuable in determining the response to therapy, surveillance for disease recurrence, and in selecting patients for I-131 therapy. SPECT/CT improves the diagnostic accuracy and the interpretation confidence of MIBG scans. (18)FDG-PET/CT is an important complementary to MIBG imaging despite its lack of specificity to NB. It is valuable in cases of negative or inconclusive MIBG scans and when MIBG findings underestimate the disease status as determined from clinical and radiological findings. F-18 DOPA is promising tracer that reflects catecholamine metabolism and is both sensitive and specific. F-18 DOPA scintigraphy provides the advantages of PET/CT imaging with early and short imaging times, high spatial resolution, inherent morphologic correlation with CT, and quantitation. Regulatory and production issues currently limit the tracer's availability. PET/CT with Ga-68 DOTA appears to be useful in NB imaging and may have a unique role in selecting patients for peptide receptor radionuclide therapy with somatostatin analogues. C-11 hydroxyephedrine PET/CT is a specific PET tracer for NB, but the C-11 label that requires an on-site cyclotron production and the high physiologic uptake in the liver and kidneys limit its use. I-124 MIBG is useful for I-131 MIBG pretherapeutic dosimetry planning. Its use for diagnostic imaging as well as the use of F-18 labeled MIBG analogues is currently experimental. PET/MR imaging is emerging and is likely to become an important tool in the evaluation. It provides metabolic and superior morphological data in one imaging session, expediting the diagnosis and lowering the radiation exposure. Radioactive iodines not only detect residual tissue and metastatic disease but also are used in the treatment of differentiated thyroid cancer. However, these are not well documented in pediatric age group like adult patients. Use of radioactivity in pediatric population is very important and strictly controlled because of the possibility of secondary malignities; therefore, management of oncological cases requires detailed literature knowledge. This article aims to review the literature on the use of radionuclide imaging and therapy in pediatric population with thyroid cancer, sarcomas, lymphoma, and NB.
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Affiliation(s)
- Pınar Özgen Kiratli
- Department of Nuclear Medicine, Hacettepe University Medical Center, Ankara, Turkey.
| | - Murat Tuncel
- Department of Nuclear Medicine, Hacettepe University Medical Center, Ankara, Turkey
| | - Zvi Bar-Sever
- Department of Nuclear Medicine, Schneider Children's Medical Center, Petah Tikva, Israel
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Radetti G, Salerno M, Guzzetti C, Cappa M, Corrias A, Cassio A, Cesaretti G, Gastaldi R, Rotondi M, Lupi F, Fanolla A, Weber G, Loche S. Thyroid function in children and adolescents with Hashimoto's thyroiditis after l-thyroxine discontinuation. Endocr Connect 2017; 6:206-212. [PMID: 28348002 PMCID: PMC5434746 DOI: 10.1530/ec-17-0023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 03/27/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Thyroid function may recover in patients with Hashimoto's thyroiditis (HT). DESIGN To investigate thyroid function and the need to resume l-thyroxine treatment after its discontinuation. SETTING Nine Italian pediatric endocrinology centers. PATIENTS 148 children and adolescents (25 m and 123 f) with HT on treatment with l-thyroxine for at least one year. INTERVENTION AND MAIN OUTCOME MEASURE Treatment was discontinued in all patients, and serum TSH and fT4 concentrations were measured at the time of treatment discontinuation and then after 2, 6, 12 and 24 months. Therapy with l-thyroxine was re-instituted when TSH rose >10 U/L and/or fT4 was below the normal range. The patients were followed up when TSH concentrations were between 5 and 10 U/L and fT4 was in the normal range. RESULTS At baseline, TSH was in the normal range in 139 patients, and was between 5 and 10 U/L in 9 patients. Treatment was re-instituted after 2 months in 37 (25.5%) patients, after 6 months in 13 patients (6.99%), after 12 months in 12 patients (8.6%), and after 24 months in an additional 3 patients (3.1%). At 24 months, 34 patients (34.3%) still required no treatment. TSH concentration >10 U/L at the time of diagnosis was the only predictive factor for the deterioration of thyroid function after l-thyroxine discontinuation. CONCLUSIONS This study confirms that not all children with HT need life-long therapy with l-thyroxine, and the discontinuation of treatment in patients with a TSH level <10 U/L at the time of diagnosis should be considered.
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Affiliation(s)
| | | | - Chiara Guzzetti
- Pediatric EndocrinologyOspedale Pedatrico Microcitemico 'A. Cao' - AOB Cagliari, Cagliari, Italy
| | - Marco Cappa
- Pediatric EndocrinologyBambino Gesù Children Hospital, Roma, Italy
| | - Andrea Corrias
- Divisione di Endocrinologia PediatricaOspedale Infantile Regina Margherita, Torino, Italy
| | | | | | | | - Mario Rotondi
- Unit of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri I.R.C.C.S., ISPESL Laboratory for Endocrine Disruptors, University of Pavia, Pavia, Italy
| | | | - Antonio Fanolla
- Department of BiostatisticsRegional Hospital, Bolzano, Italy
| | - Giovanna Weber
- Department of PediatricsVita-Salute San Raffaele University, Milan, Italy
| | - Sandro Loche
- Pediatric EndocrinologyOspedale Pedatrico Microcitemico 'A. Cao' - AOB Cagliari, Cagliari, Italy
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Abstract
Autoimmune thyroid diseases (AIT) are common in children and may present with a variety of signs and symptoms including: euthyroid goiter, hypothyroidism, or hyperthyroidism. The natural history of AIT may be different in children but in all age groups, there appear to be genetic risk factors and environmental triggers that initiate thyroid autoimmunity. Areas covered: In this review, we summarize recent studies that investigate the genetics and environmental triggers believed to be involved in thyroid autoimmunity. We also discuss the approach and controversies in the treatment of children with AIT. Expert commentary: Much has been learned about the major roles for genetics, cytokines, regulatory lymphocytes, and environmental triggers in CLT but controversies remain.
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Affiliation(s)
- Prasanthi Pasala
- a Pediatric Endocrinology and Metabolism, Department of Pediatrics , Children's Hospital of Richmond at Virginia Commonwealth University , Richmond , VA , USA
| | - Gary L Francis
- a Pediatric Endocrinology and Metabolism, Department of Pediatrics , Children's Hospital of Richmond at Virginia Commonwealth University , Richmond , VA , USA
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Keskin M, Savas-Erdeve S, Aycan Z. Co-Existence of Thyroid Nodule and Thyroid Cancer in Children and Adolescents with Hashimoto Thyroiditis: A Single-Center Study. Horm Res Paediatr 2016; 85:181-7. [PMID: 26910846 DOI: 10.1159/000443143] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 12/04/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Currently, there is an inadequate number of studies on nodule and malignancy development in children and adolescents with Hashimoto thyroiditis (HT). MATERIAL AND METHODS Patients who were diagnosed with HT between 2004 and 2013 were included in the study. The HT diagnosis was made with a heterogeneous appearance on thyroid ultrasonography and the elevation of antithyroid peroxidase and/or anti-thyroglobulin antibodies. Fine-needle aspiration biopsy (FNAB) was performed in cases with a nodule size >1 cm or who had ultrasonography findings indicating malignancy. RESULTS A total of 39 (13%) thyroid nodules were detected in 300 patients with a diagnosis of HT. Papillary thyroid carcinoma (PTC) was diagnosed in 2 of the 12 cases in whom FNAB was performed. The thyroid nodule was detected at the same time as HT in the 2 cases with malignancy. The PTC diagnosis was made 2 years after the HT diagnosis in the first case and 3 years later in the second case. The largest diameter of the thyroid nodule was 5 mm in both cases. CONCLUSION The thyroid nodule rate on an HT background was found to be 13%, and the thyroid malignancy rate was 0.67% in our study.
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Abstract
PURPOSE OF REVIEW The review is focused on new information about the presentation and management of thyroid nodules in children and adolescents. RECENT FINDINGS Palpable thyroid nodules are uncommon in children but many children have nodules detected by radiologic imaging. How to evaluate them, when to suspect thyroid cancer, and how best to follow apparently benign nodules has become an area of great interest. The American Thyroid Association recently published treatment guidelines for children with thyroid nodules and cancers but much has been learned since that publication. SUMMARY Personal and family history, ultrasound features, and fine needle aspiration cytology are used to determine the risk of cancer in thyroid nodules, which are then managed according to cancer risk.
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Abstract
Well differentiated thyroid cancer (DTC) in children is characterized by a high rate of response to treatment and low disease-specific mortality. Treatment of children with DTC has evolved toward a greater reliance on evaluation and monitoring with serial serum thyroglobulin measurements and ultrasound examinations. Radioiodine therapy is recommended for thyroid remnant ablation in high-risk patients, treatment of demonstrated radioiodine-avid local-regional disease not amenable to surgical resection, or distant radioiodine-avid metastatic disease. Sufficient time should be given for benefits of radioiodine therapy to be realized, with follow-up monitoring. Re-treatment with radioiodine can be deferred until progression of significant disease manifests.
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Affiliation(s)
- Josef Machac
- Nuclear Medicine, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, Box 1141, 1 Gustave Levy Place, New York, NY 10029, USA.
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45
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Nikita ME, Jiang W, Cheng SM, Hantash FM, McPhaul MJ, Newbury RO, Phillips SA, Reitz RE, Waldman FM, Newfield RS. Mutational Analysis in Pediatric Thyroid Cancer and Correlations with Age, Ethnicity, and Clinical Presentation. Thyroid 2016; 26:227-34. [PMID: 26649796 PMCID: PMC4985048 DOI: 10.1089/thy.2015.0401] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Well-differentiated thyroid cancer (WDTC) incidence in pediatrics is rising, most being papillary thyroid carcinoma (PTC). The objective of the study was to assess the prevalence of different mutations in pediatric WDTC and correlate the genotype with the clinical phenotype. METHODS This is a single-center retrospective study. Thyroid tissue blocks from 42 consecutive pediatric WDTC patients who underwent thyroidectomy between 2001 and 2013 were analyzed at Quest Diagnostics for BRAF(V600E), RAS mutations (N,K,H), and RET/PTC and PAX8/PPARγ rearrangements, using validated molecular methods. Thyroid carcinomas included PTC, follicular thyroid carcinoma (FTC), and follicular variant of PTC (FVPTC). RESULTS Thirty-nine samples (29 females) were genotyped. The mean age at diagnosis was 14.7 years (range 7.9-18.4 years), and most were Hispanic (56.4%) or Caucasian (35.9%). The mean follow-up period was 2.9 years. Mutations were noted in 21/39 (53.8%), with both BRAF(V600E) (n = 9), and RET/PTC (n = 6) detected only in PTC. Mutations were detected in 2/5 FTC (PAX8/PPARγ and NRAS) and 3/6 FVPTC cases (PAX8/PPARγ). Of 28 PTC patients, 57.1% had mutations: 32.1% with BRAF(V600E), 21.4% with RET/PTC, and 3.6% with NRAS. Of patients with BRAF(V600E), 77.8% were Hispanic and 88.9% were >15 years, while all RET/PTC-positive patients were ≤15 years (p = 0.003). Tumor size, lymph node involvement, and distant metastasis at diagnosis (or soon after (131)I ablation) did not vary significantly based on the mutation. CONCLUSIONS BRAF(V600E) was the most common mutation, especially in older and Hispanic adolescents. A larger, ethnically diverse pediatric cohort followed long term will enable the genotypic variability, clinical presentation, and response to therapy to be better assessed.
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Affiliation(s)
- Maria Eleni Nikita
- Division of Pediatric Endocrinology, University of California, San Diego, and Rady Children's Hospital San Diego, California
| | - Wen Jiang
- Division of Pediatric Otolaryngology, University of California, San Diego, and Rady Children's Hospital San Diego, California
| | - Shih-Min Cheng
- Hematology and Oncology, Quest Diagnostics Nichols Institute, San Juan Capistrano, California
| | - Feras M. Hantash
- Hematology and Oncology, Quest Diagnostics Nichols Institute, San Juan Capistrano, California
| | - Michael J. McPhaul
- Hematology and Oncology, Quest Diagnostics Nichols Institute, San Juan Capistrano, California
| | - Robert O. Newbury
- Department of Pathology, University of California, San Diego, and Rady Children's Hospital San Diego, California
| | - Susan A. Phillips
- Division of Pediatric Endocrinology, University of California, San Diego, and Rady Children's Hospital San Diego, California
| | - Richard E. Reitz
- Hematology and Oncology, Quest Diagnostics Nichols Institute, San Juan Capistrano, California
| | - Frederic M. Waldman
- Hematology and Oncology, Quest Diagnostics Nichols Institute, San Juan Capistrano, California
| | - Ron S. Newfield
- Division of Pediatric Endocrinology, University of California, San Diego, and Rady Children's Hospital San Diego, California
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46
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Diagnostic performance of thyroid ultrasonography screening in pediatric patients with a hypothyroid, hyperthyroid or euthyroid goiter. Pediatr Radiol 2016; 46:104-11. [PMID: 26298554 DOI: 10.1007/s00247-015-3435-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 05/19/2015] [Accepted: 07/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Goiter is frequently the first indicator of thyroid disease in children. OBJECTIVE To evaluate the usefulness of ultrasonography (US) in the identification of potential malignant nodules and autoimmune thyroiditis in children with diffuse goiter. MATERIALS AND METHODS This study consisted of 113 patients <20 years with a diffuse goiter who underwent thyroid US. Parenchymal echogenicity and the presence of nodules and abnormal lymph nodes were evaluated on US; if a thyroid nodule was detected, its characteristics were analyzed. The diagnostic accuracy of the US findings in the diagnosis of autoimmune thyroid disease was assessed. RESULTS Thyroid nodules were detected on US in 72 of the 113 (63.7%) patients. Of these, 65 (90.3%) had probably benign nodules and 4 (5.6%) patients had nodules suspicious of malignancy. The remaining had indeterminate nodules only. In one child with suspected malignant nodules, papillary thyroid cancer with coexisting autoimmune thyroiditis was confirmed. Hypoechogenicity was visualized in 23 (88.5%) patients with autoimmune thyroiditis and 12 (85.7%) with Graves disease. The sensitivity and specificity of micronodulation for autoimmune thyroiditis were 53.9% and 98.3%, respectively. CONCLUSION Although the potential for malignant nodules is relatively low in children with diffuse goiter, US can detect focal thyroid disease and characterize the nodules. US thus plays a useful role in excluding autoimmune thyroiditis in this population.
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47
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Iliadou PK, Effraimidis G, Konstantinos M, Grigorios P, Mitsakis P, Patakiouta F, Pazaitou-Panayiotou K. Chronic lymphocytic thyroiditis is associated with invasive characteristics of differentiated thyroid carcinoma in children and adolescents. Eur J Endocrinol 2015; 173:827-33. [PMID: 26369577 DOI: 10.1530/eje-14-1046] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 09/08/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND The association between chronic lymphocytic thyroiditis (CLT) and thyroid cancer is an interesting topic. The aim of the present study was to evaluate if demographic and histological characteristics as well as the long-term outcome of thyroid cancer was different in children and adolescents with and without CLT. METHODS The medical records of children and adolescents (≤21 years old) were reviewed. The following data were recorded: gender, year and age at diagnosis, family history of thyroid cancer, history of external radiation therapy, histological type (papillary and variants, follicular and variants), tumour size, multifocality, infiltration of thyroid parenchyma or surrounding soft tissues, vascular invasion, presence of lymph node and distant metastases. Information about the presence of TgAb and TPOAb was also collected. RESULTS One hundred eight children and adolescents (median age 19.0, interquartile range 4.0 years) were diagnosed with differentiated thyroid carcinoma (DTC); 31 patients (28.7%) presented histological characteristics compatible with CLT. Infiltration of thyroid parenchyma was more frequent in patients with CLT compared to patients without (74.2% vs 48.1% respectively, P=0.024). Familial papillary thyroid carcinoma (PTC) was more frequent in patients with CLT compared to those without CLT (20.7% vs 2.8% respectively, P=0.009). There was no better outcome with respect to the presence of CLT or not. CONCLUSIONS Children and adolescents with CLT present more frequently familial PTC as well as thyroid cancer with invasive characteristics.
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Affiliation(s)
- Paschalia K Iliadou
- Department of EndocrinologyTheagenio Cancer Hospital, 2, Al Simeonidi Street, 54007 Thessaloniki, GreeceEndocrinology SectionInternal Medicine Department, Nykobing Falster Hospital, Nykobing Falster, DenmarkDepartment of PathologyTheagenio Cancer Hospital, Thessaloniki, Greece
| | - Grigoris Effraimidis
- Department of EndocrinologyTheagenio Cancer Hospital, 2, Al Simeonidi Street, 54007 Thessaloniki, GreeceEndocrinology SectionInternal Medicine Department, Nykobing Falster Hospital, Nykobing Falster, DenmarkDepartment of PathologyTheagenio Cancer Hospital, Thessaloniki, Greece
| | - Michalakis Konstantinos
- Department of EndocrinologyTheagenio Cancer Hospital, 2, Al Simeonidi Street, 54007 Thessaloniki, GreeceEndocrinology SectionInternal Medicine Department, Nykobing Falster Hospital, Nykobing Falster, DenmarkDepartment of PathologyTheagenio Cancer Hospital, Thessaloniki, Greece
| | - Panagiotou Grigorios
- Department of EndocrinologyTheagenio Cancer Hospital, 2, Al Simeonidi Street, 54007 Thessaloniki, GreeceEndocrinology SectionInternal Medicine Department, Nykobing Falster Hospital, Nykobing Falster, DenmarkDepartment of PathologyTheagenio Cancer Hospital, Thessaloniki, Greece
| | - Periklis Mitsakis
- Department of EndocrinologyTheagenio Cancer Hospital, 2, Al Simeonidi Street, 54007 Thessaloniki, GreeceEndocrinology SectionInternal Medicine Department, Nykobing Falster Hospital, Nykobing Falster, DenmarkDepartment of PathologyTheagenio Cancer Hospital, Thessaloniki, Greece
| | - Frideriki Patakiouta
- Department of EndocrinologyTheagenio Cancer Hospital, 2, Al Simeonidi Street, 54007 Thessaloniki, GreeceEndocrinology SectionInternal Medicine Department, Nykobing Falster Hospital, Nykobing Falster, DenmarkDepartment of PathologyTheagenio Cancer Hospital, Thessaloniki, Greece
| | - Kalliopi Pazaitou-Panayiotou
- Department of EndocrinologyTheagenio Cancer Hospital, 2, Al Simeonidi Street, 54007 Thessaloniki, GreeceEndocrinology SectionInternal Medicine Department, Nykobing Falster Hospital, Nykobing Falster, DenmarkDepartment of PathologyTheagenio Cancer Hospital, Thessaloniki, Greece
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Mussa A, De Andrea M, Motta M, Mormile A, Palestini N, Corrias A. Predictors of Malignancy in Children with Thyroid Nodules. J Pediatr 2015; 167:886-892.e1. [PMID: 26164379 DOI: 10.1016/j.jpeds.2015.06.026] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 05/06/2015] [Accepted: 06/08/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of clinical, laboratory, and ultrasound (US) imaging characteristics of thyroid nodules in assessing the likelihood of malignancy. STUDY DESIGN Data from 184 children and adolescents with thyroid nodules were evaluated and compared with respective cytologic/histologic outcomes. A regression model was designed to assess the predictors associated with malignancy and to calculate ORs. RESULTS Twenty-nine malignant neoplasms (25 papillary, 1 medullary, 3 Hurtle-cell carcinomas), 8 follicular adenomas, and 147 goitrous nodules (92 based on cytology, 55 on follow-up) were diagnosed. Fine-needle aspiration biopsy diagnostic accuracy, sensitivity, and specificity were 91%, 100%, and 88%, respectively. Male sex, compression symptoms, palpable lymphopathy, thyroid stimulating hormone concentration, microcalcifications, indistinct margins, hypoechoic US pattern, pathologic lymph node alterations, and increased intranodular vascularization were associated with malignancy. Regular margins, mixed echoic pattern, and peripheral-only vascularization were associated with benignity. During follow-up, nodule growth was associated with malignant disease, especially with levothyroxine therapy. A multivariate analysis confirmed that microcalcifications, hypoechoic pattern, intranodular vascularization, lymph node alterations, and thyroid stimulating hormone concentration were independent predictors of malignant outcome. For each predictor, we provide sensitivity, specificity, and positive/negative predictive values. CONCLUSIONS Clinical, laboratory, and US features of nodules can be used as predictors of malignancy in children. Although none has diagnostic accuracy as high as that of fine-needle aspiration biopsy, these predictors should be considered in deciding the diagnostic approach of children with thyroid nodules.
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Affiliation(s)
- Alessandro Mussa
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy.
| | - Maurilio De Andrea
- Endocrinology, Diabetes and Metabolic Disease Unit, Azienda Ospedaliera Ordine Mauriziano, Torino, Italy
| | - Manuela Motta
- Anatomical Pathology Unit, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Italy
| | - Alberto Mormile
- Endocrinology, Diabetes and Metabolic Disease Unit, Azienda Ospedaliera Ordine Mauriziano, Torino, Italy
| | - Nicola Palestini
- General Surgery, Department of Medical and Surgical Sciences, University of Torino, Ospedale Molinette, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Andrea Corrias
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
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Kakleas K, Soldatou A, Karachaliou F, Karavanaki K. Associated autoimmune diseases in children and adolescents with type 1 diabetes mellitus (T1DM). Autoimmun Rev 2015; 14:781-97. [DOI: 10.1016/j.autrev.2015.05.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 05/06/2015] [Indexed: 12/16/2022]
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50
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Francis GL, Waguespack SG, Bauer AJ, Angelos P, Benvenga S, Cerutti JM, Dinauer CA, Hamilton J, Hay ID, Luster M, Parisi MT, Rachmiel M, Thompson GB, Yamashita S. Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2015; 25:716-59. [PMID: 25900731 PMCID: PMC4854274 DOI: 10.1089/thy.2014.0460] [Citation(s) in RCA: 687] [Impact Index Per Article: 76.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Previous guidelines for the management of thyroid nodules and cancers were geared toward adults. Compared with thyroid neoplasms in adults, however, those in the pediatric population exhibit differences in pathophysiology, clinical presentation, and long-term outcomes. Furthermore, therapy that may be recommended for an adult may not be appropriate for a child who is at low risk for death but at higher risk for long-term harm from overly aggressive treatment. For these reasons, unique guidelines for children and adolescents with thyroid tumors are needed. METHODS A task force commissioned by the American Thyroid Association (ATA) developed a series of clinically relevant questions pertaining to the management of children with thyroid nodules and differentiated thyroid cancer (DTC). Using an extensive literature search, primarily focused on studies that included subjects ≤18 years of age, the task force identified and reviewed relevant articles through April 2014. Recommendations were made based upon scientific evidence and expert opinion and were graded using a modified schema from the United States Preventive Services Task Force. RESULTS These inaugural guidelines provide recommendations for the evaluation and management of thyroid nodules in children and adolescents, including the role and interpretation of ultrasound, fine-needle aspiration cytology, and the management of benign nodules. Recommendations for the evaluation, treatment, and follow-up of children and adolescents with DTC are outlined and include preoperative staging, surgical management, postoperative staging, the role of radioactive iodine therapy, and goals for thyrotropin suppression. Management algorithms are proposed and separate recommendations for papillary and follicular thyroid cancers are provided. CONCLUSIONS In response to our charge as an independent task force appointed by the ATA, we developed recommendations based on scientific evidence and expert opinion for the management of thyroid nodules and DTC in children and adolescents. In our opinion, these represent the current optimal care for children and adolescents with these conditions.
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Affiliation(s)
- Gary L. Francis
- Division of Pediatric Endocrinology, Virginia Commonwealth University, Children's Hospital of Richmond, Richmond, Virginia
| | - Steven G. Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders and Department of Pediatrics-Patient Care, Children's Cancer Hospital, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrew J. Bauer
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, The University of Pennsylvania, The Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Peter Angelos
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Salvatore Benvenga
- University of Messina, Interdepartmental Program on Clinical & Molecular Endocrinology, and Women's Endocrine Health, A.O.U. Policlinico Universitario G. Martino, Messina, Italy
| | - Janete M. Cerutti
- Department of Morphology and Genetics. Division of Genetics, Federal University of São Paulo, São Paulo, Brazil
| | - Catherine A. Dinauer
- Department of Surgery, Division of Pediatric Surgery, Department of Pediatrics, Division of Pediatric Endocrinology, Yale University School of Medicine, New Haven, Connecticut
| | - Jill Hamilton
- Division of Endocrinology, University of Toronto, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ian D. Hay
- Division of Endocrinology, Mayo Clinic and College of Medicine, Rochester, Minnesota
| | - Markus Luster
- University of Marburg, Marburg, Germany
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Marguerite T. Parisi
- Departments of Radiology and Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Department of Radiology, Seattle, Washington
| | - Marianna Rachmiel
- Pediatric Division, Assaf Haroffeh Medical Center, Zerifin, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Geoffrey B. Thompson
- Department of Surgery, Division of Subspecialty GS (General Surgery), Mayo Clinic, Rochester, Minnesota
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