Features and outcome of autonomous thyroid nodules in children: 31 consecutive patients seen at a single center

Abstract

Context: Most thyroid nodules are benign and their accurate identification can avoid unnecessary procedures. In adult patients, documentation of nodule autonomy is accepted as reassurance of benign histology and as justification to forgo biopsy or thyroidectomy. In contrast, the negative predictivevalueofnoduleautonomyinchildrenisuncertain.Somerecentpublicationsrecommend surgical resection as initial management, but few address the degree of TSH suppression or the specific scintigraphic criteria used to diagnose autonomy. Objective: The objective of the study was to study the presenting features and cancer risk of children with autonomous nodules. Design and Setting: Medical records of all 31 children diagnosed with autonomous nodules at our center from 2003 to 2014 were retrospectively reviewed. Patients and Results: All children met full diagnostic criteria for autonomous nodules, defined by both autonomous 123I uptake into the nodule and the suppression of uptake in the normal thyroid parenchyma on scintigraphy performed during hypothyrotropinemia. The median age of presentationwas15years(range3-18y)withafemaletomaleratioof15:1.Fifty-eightpercentofpatients had solitary nodules and 42% had multiple nodules. The median size of each patient's largest autonomous nodule was 39 mm (range 18-67 mm). Most of the children in this series (68%) had diagnosticbiopsiesand/oroperativepathologyoftheirlargestautonomousnodule,whichshowed benign cytology or histology in all cases. Conclusions: In this pediatric series, the cancer rate observed in biopsied or resected autonomous nodules was 0%. Whereas larger studies are needed to confirm our findings, these results agree with earlier reports suggesting that thyroid cancer is rare in rigorously defined autonomous nodules and supportthatconservativemanagementmaybeofferedtoselectedchildrenwhomeetstrictdiagnostic criteria for autonomous nodules, deferring definitive therapies until adulthood when the risks of thyroidectomy and 131I ablation are lower.