Thyroid Nodules and Tumors in Pediatrics, Thyroid Carcinoma in Children, Medullary Carcinoma of the Thyroid

What is the prevalence and nature of solitary thyroid nodules in children?

Solitary thyroid nodules occur in approximately 2% of children, with the majority being benign.

What steps are involved in the evaluation of thyroid nodules in pediatric patients?

1. Thyroid Function Tests (TFTs): Assess TSH, T3, and T4 levels to evaluate nodule activity.

2. Neck Ultrasound (US): Helps determine nodule size, composition, and the presence of suspicious features (e.g., calcifications, irregular borders).

3. Fine-Needle Aspiration (FNA): Performed if US findings are concerning or if the nodule is large; can be done with or without US guidance for accurate sampling.

How common is thyroid carcinoma in children, and what types are most prevalent?

Thyroid carcinoma is rare in children, comprising only 1% of all pediatric cancers in the 5-9 year age group. The majority (90%) are papillary and follicular carcinomas.

What are the risk factors for developing thyroid carcinoma in pediatric patients?

The primary risk factor for thyroid carcinoma in children is a history of head or neck irradiation.

Describe the clinical features of thyroid carcinoma in children.

1. Presentation: Typically appears as a firm to hard, painless, nonfunctional solitary nodule.

2. Possible Spread: May extend to adjacent lymph nodes.

3. Other Symptoms: Rapid growth of the nodule, hoarseness (due to recurrent laryngeal nerve involvement), and possible lung metastasis.

What diagnostic procedures are used to confirm thyroid carcinoma?

1. Excisional Biopsy: Often performed to confirm diagnosis.

2. Fine-Needle Aspiration (FNA): May sometimes be sufficient for diagnosis, particularly with US guidance.

Outline the treatment approach for thyroid carcinoma in pediatric patients.

1. Surgical Treatment: Total thyroidectomy to remove all thyroid tissue.

2. Regional Node Dissection: Selective dissection of affected lymph nodes.

3. Radioiodine Therapy (131-I): Used for ablation of any residual or recurrent disease, particularly for cases that cannot be fully resected surgically.

What is medullary thyroid carcinoma, and how does it typically present in children?

Medullary carcinoma is a rare type of thyroid cancer in children, which may be asymptomatic aside from a palpable mass.

How is medullary thyroid carcinoma diagnosed, and what is its common association?

1. Diagnosis: Confirmed through elevated calcitonin levels.

2. Association: Often occurs in conjunction with Multiple Endocrine Neoplasia (MEN) syndromes, especially MEN type 2.