Universidad Autónoma de Ciudad Juárez
Instituto de Ciencias Biomédicas
Departamento de Licenciatura en Enfermería
“Articulo del Nódulo Tiroideo”
José Luis Flores Dueñas
Fecha: 01 de Noviembre del 2013
A Standardized Assessment of Thyroid Nodules in Children Confirms Higher Cancer Prevalence Than in Adults
Gupta A, Ly S, Castroneves LA, et al
J ClinEndocrinol Metab. 2013;98:3238-3245
This study by Gupta and colleagues systematically analyzed the clinical characteristics and risk for thyroid nodules to harbor thyroid cancer in the pediatric population. Pediatric patients were approached in a defined manner that included clinical examination, measurement of serum thyroid-stimulating hormone (TSH), and thyroid ultrasound.If a thyroid nodule that is 1 cm or larger was identified, ultrasound-guided fine needle aspiration (FNA) was performed. Patients with a low serum TSH had a 123-I thyroid scan. If an autonomous nodule was found, thyroid FNA was not performed.
Findings were compared with a control population of adults. Of 300 children who were originally referred for thyroid nodule evaluation, 125 had thyroid FNAafter a nodule larger than 1 cm was found. In this group, the incidence of thyroid cancer was 22%, a value that is significantly higher than the rate of thyroid cancer in nodules in adults (5%-14%). The authors concluded by noting the high likelihood that a child referred for evaluation of possible thyroid nodules will not require a thyroid FNA and will have a benign condition. On the other hand,however, there is a 22% chance that a thyroid nodule identified by ultrasound that is 1 cm or larger will harbor thyroid cancer.
The majority of articles about thyroid nodules and thyroid cancer assess them in adult patients.Clinically detectable thyroid nodules occur in approximately 1% of men and 5% of women.[3,4] However, more sensitive methods of detection, such as ultrasound, havedetected thyroid nodules in a much higher percentage of the population. It is estimated that about 5%-15% of thyroid nodules will harbor cancer, depending on multiple factors such as nodule size, the patient's sex, family history, and the type and amount of radiation exposure.[6,7]
Thyroid nodules and thyroid cancer have been much less extensively studied in children. The American Thyroid AssociationGuidelines have reviewed the literature on this topic and recommend that the diagnostic and therapeutic approach to thyroid nodules in a child should be the same as for an adult.This evaluation is important because there are some obvious differences to consider in children compared with adults. It is uncertain at what age an individual should still be considered a child for these purposes. Itis difficult and more disconcerting to a child to undergo radiologic studies and thyroid FNA. Should a 2-year-old child be evaluated similarly as an 18-year-old? Moreover, the incidence of thyroid nodules is lower in children, but the percentage of these nodules that harbor thyroid cancer is not as clear as in adults.
This study by Gupta retrospectively analyzed 300 consecutive children withpossible thyroid nodules who were referred to a multidisciplinary pediatric thyroid cancer clinic. For various valid reasons (eg, history of radiation, familial thyroid cancer, referral bias), some patients were excluded. They analyzed 125 patients (136 FNAs) with thyroid nodules on ultrasound that were 1 cm or larger in size. FNA was performed on all nodules and was well tolerated. Patients didnot require sedation except for 2 patients who were younger than 6 years of age. The female-to-male ratio of the nodules was 5:2. Patients were referred for thyroid surgery if they had cytologic abnormalities that indicated concern for cancer or if the nodule was 4 cm or larger. Thyroid cancer was identified in 28 patients for an incidence of 22%. The presence of coexistent Hashimoto thyroiditis...
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