Thyroidectomy in children and adolescents: distinguishing benign from malignant thyroid nodules

Abstract

Objectives: The research aimed to analyze the clinical, epidemiological, laboratory, imaging, and pathological characteristics of pediatric patients who underwent surgery for thyroid nodules, distinguishing and comparing malignant and benign conditions.

Methodology: A retrospective and descriptive analysis was conducted on patients aged 0-18 years who underwent thyroidectomy. The following variables were evaluated: gender, previous and current pathological history, laboratory thyroid hormone levels, ultrasonography, cytology, and histopathological findings.

Results: A total of 91 children underwent thyroidectomy from January 2013 to May 2023. The average age was 13 years, and 68 patients were female. Ultrasonography evaluation revealed that 62 children had unimodular disease. Histopathology reports showed benign tumors in 54 patients and malignant tumors in 37. The factors associated with a higher incidence of cancer in univariate analysis were age < 10 years (p = 0.025), the presence of nodules on ultrasound with microcalcification (p < 0.001), and hypoechogenic nodules (p = 0.007). On multivariate analysis, only age under 10 years (OR = 5.69; p = 0.028) and the presence of microcalcifications (OR = 28.44 and p = 0.002) were significantly associated with malignancy.

Conclusion: The medical community is becoming increasingly aware of the differences in the clinical, epidemiological, pathological, and molecular presentations of benign and malignant thyroid diseases, highlighting the need for further training in this area.

Keywords: Children; Nodule; Thyroidectomy.

Figure 1

Flow chart summarizing the type of surgery and the histopathological diagnosis.

Figure 2

Receiver Operating Characteristic (ROC) curve for the predictive model including age ≤ 10 years, nodule composition, and presence of microcalcifications, for malignancy in thyroid nodules.