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Nam, Chang, Hong, Hwang, Lim, Lee, and Lee: Characteristic Sonographic and Follow Up Features of Thyroid Nodules According to Childhood Age Groups
Pediatric Radiology
Original Article

Journal of the Korean Society of Radiology 2016; 75(2): 126-132.

Published online: 27 July 2016

DOI: https://doi.org/10.3348/jksr.2016.75.2.126

Characteristic Sonographic and Follow Up Features of Thyroid Nodules According to Childhood Age Groups

Bo Da Nam, MD1, Yun-Woo Chang, MD1, Seong Sook Hong, MD1, Ji-Young Hwang, MD1, Hyun Kyung Lim, MD1, Jeong Ho Lee, MD2, Dong Hwan Lee, MD2

1Department of Radiology, Soonchunhyang University Hospital, Seoul, Korea.

2Department of Pediatrics, Soonchunhyang University Hospital, Seoul, Korea.

Corresponding author: Yun-Woo Chang, MD. Department of Radiology, Soonchunhyang University Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul 04401, Korea. Tel. 82-2-709-9396 Fax. 82-2-709-3928, ywchang@schmc.ac.kr

Received 7 July 2015       Revised 22 September 2015       Accepted 7 May 2016

Copyright © 2016 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We analyzed the spectrum and the significance of pediatric thyroid nodules depicted on sonography and evaluated the follow-up change according to the age group.

Materials and Methods

We retrospectively reviewed the sonographic features of 82 nodules in 69 patients (6.6%) among 1282 children less than 13 years of age without a palpable lesion, from January 2006 to January 2013. Patients were divided into three age groups; infants, preschoolers, and schoolers. Thyroid nodules were evaluated according to their sonographic characteristics (simple cyst, colloid cyst, solid mass, or intrathyroid thymus) and the changes detected at follow-up (disappearance, decrease in size, no change or increase in size) were reported.

Results

There was a significant difference in the nodule patterns among the age groups (p < 0.001). The nodules in infants included a simple cyst (n = 12), a solid mass (n = 12), or an intra-thyroid thymus (n = 9). The preschoolers had a simple cyst (n = 11), a colloid cyst (n = 5), a solid mass (n = 3) or an intra-thyroid thymus (n = 5). However, the schoolers had a simple cyst (n = 2), a colloid cyst (n = 18), and a solid mass (n = 5), but there was no case of intra-thyroid thymus. Follow-up of 38 cases revealed significant differences among the age groups (p = 0.018). The nodules in infants showed findings such as disappearance of nodules (n = 9) and no change (n = 10) on follow-up sonography. In preschoolers, the nodules had disappeared (n = 2), decreased in size (n = 1), and showed no change (n = 11). However, the nodules in schoolers were found to be decreased in size (n = 1), show no change (n = 2), and increased in size (n = 2). The proven pathologic finding was benign in four patients.

Conclusion

There were significant differences in the prevalence and the interval change of thyroid nodules among infants, preschoolers, and schoolers. A large series of intrathyroid thymus was seen in infants and preschoolers, and masses did not increase in size in these age groups. The frequency of a colloid cyst could be increased in schoolers, and masses were increased in size in this age group, but none of the patients showed a malignant finding on pathology.

Keywords: Thyroid Nodule, Ultrasonography, Pediatrics

Figures and Tables

Fig. 1

Intrathyroid thymus is defined as a hypoechoic mass with multiple punctuate echogenic foci (arrow), showing same sonographic appearance as the thymus (T).

A. Transverse scan.
B. Longitudinal scan.
jksr-75-126-g001
Fig. 2

Multiple colloid cysts are evident in the right lower pole of the thyroid in an 11-year-old girl with a clinical history of tonsillitis.

jksr-75-126-g002
Fig. 3

Longitudinal sonogram of thyroid gland shows target-like lesions with an echogenic center and a hypoechoic peripheral rim (arrow). The lesion was disappeared on follow-up ultrasonography (not included in figure).

jksr-75-126-g003
Fig. 4

A. There is circumscribed, oval, hypoechoic solid mass in the right upper pole of the thyroid gland in an 8-year-old boy.

B. The mass is increased in size (1.43 mL to 3.00 mL) at the 5-year follow-up examination. The patient underwent a core needle biopsy of the mass. The histological diagnosis was Hurthle cell adenoma.
jksr-75-126-g004
Table 1

Sonographic Mass Patterns and Follow Up Changes According to Mass Pattern

jksr-75-126-i001
Age Group Mass Pattern Number (%) Follow Up Change, Number (%)
None Disappear Decreased No Change Increased p-Value
Infants 33 (40.2) 14 (42.4) 9 (27.3) 0 (0) 10 (30.3) 0 (0) 0.141
 Simple cyst 12 (14.6) 5 (15.2) 5 (15.2) 0 (0) 2 (6.1) 0 (0)
 Colloid cyst 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
 Solid mass 12 (14.6) 3 (9.1) 4 (12.1) 0 (0) 5 (15.2) 0 (0)
 Intrathyroid thymus 9 (11.0) 6 (18.2) 0 (0) 0 (0) 3 (9.1) 0 (0)
Preschooler 24 (29.3) 10 (41.7) 2 (8.3) 1 (4.2) 11 (45.8) 0 (0) 0.126
 Simple cyst 11 (3.4) 7 (29.2) 2 (8.3) 1 (4.2) 1 (4.2) 0 (0)
 Colloid cyst 5 (6.1) 0 (0) 0 (0) 0 (0) 5 (20.8) 0 (0)
 Solid mass 3 (3.7) 1 (4.2) 0 (0) 0 (0) 2 (8.3) 0 (0)
 Intrathyroid thymus 5 (6.1) 2 (8.3) 0 (0) 0 (0) 3 (12.5) 0 (0)
Schooler 25 (30.5) 20 (80.0) 0 (0) 1 (4.0) 2 (8.0) 2 (8.0) 0.029
 Simple cyst 2 (2.4) 2 (8.0) 0 (0) 0 (0) 0 (0) 0 (0)
 Colloid cyst 18 (22.0) 16 (64.0) 0 (0) 0 (0) 2 (8.0) 0 (0)
 Solid mass 5 (6.1) 2 (8.0) 0 (0) 1 (4.0) 0 (0) 2 (8.0)
 Intrathyroid thymus 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
Total 82 (100) 44 (53.7) 11 (13.4) 2 (2.4) 23 (28.0) 2 (2.4) 0.018

Infants (< 1 year), preschoolers (1–5 years), and schoolers (6–13 years)

Acknowledgments

This work was supported by Soonchunhyang University Research Fund.

References

1. Babcock DS. Thyroid disease in the pediatric patient: emphasizing imaging with sonography. Pediatr Radiol. 2006; 36:299–308. quiz 372-373.
2. Mirshemirani A, Roshanzamir F, Tabari AK, Ghorobi J, Salehpoor S, Gorji FA. Thyroid nodules in childhood: a single institute experience. Iran J Pediatr. 2010; 20:91–96.
3. Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med. 1993; 328:553–559.
4. Niedziela M. Pathogenesis, diagnosis and management of thyroid nodules in children. Endocr Relat Cancer. 2006; 13:427–453.
5. Hegedüs L. Clinical practice. The thyroid nodule. N Engl J Med. 2004; 351:1764–1771.
6. Francis GL, Waguespack SG, Bauer AJ, Angelos P, Benvenga S, Cerutti JM, et al. Management guidelines for children with thyroid nodules and differentiated thyroid cancer. Thyroi. 2015; 25:716–759.
7. Avula S, Daneman A, Navarro OM, Moineddin R, Urbach S, Daneman D. Incidental thyroid abnormalities identified on neck US for non-thyroid disorders. Pediatr Radiol. 2010; 40:1774–1780.
8. Kim HG, Kim MJ, Lee MJ. Sonographic appearance of intrathyroid ectopic thymus in children. J Clin Ultrasound. 2012; 40:266–271.
9. Segni M, di Nardo R, Pucarelli I, Biffoni M. Ectopic intrathyroidal thymus in children: a long-term follow-up study. Horm Res Paediatr. 2011; 75:258–263.
10. Chng CL, Kocjan G, Kurzawinski TR, Beale T. Intrathyroidal ectopic thymic tissue mimicking thyroid cancer in children. Endocr Pract. 2014; 20:e241–e245.
11. Durmaz E, Barsal E, Parlak M, Gurer I, Karaguzel G, Akcurin S, et al. Intrathyroidal ectopic thymic tissue may mimic thyroid cancer: a case report. J Pediatr Endocrinol Metab. 2012; 25:997–1000.
12. Megremis S, Stiakaki E, Tritou I, Bonapart IE, Tsilimigaki A. Ectopic intrathyroidal thymus misdiagnosed as a thyroid nodule: sonographic appearance. J Clin Ultrasound. 2008; 36:443–447.
13. Segni M, Nuti F, di Nardo R. Ectopic intrathyroidal thymus in an 11-year-old boy. Thyroid. 2006; 16:1179–1180.
14. Hernandez-Cassis C, Poniecka A, Vogel CK, McKenzie JM. A six-year-old boy with a suspicious thyroid nodule: intrathyroidal thymic tissue. Thyroid. 2008; 18:377–380.
15. Lignitz S, Musholt TJ, Kreft A, Engel R, Brzezinska R, Pohlenz J. Intrathyroidal thymic tissue surrounding an intrathyroidal parathyroid gland, the cause of a solitary thyroid nodule in a 6-year-old boy. Thyroid. 2008; 18:1125–1130.
16. Gimm O, Krause U, Wessel H, Finke R, Dralle H. Ectopic intrathyroidal thymus diagnosed as a solid thyroid lesion: case report and review of the literature. J Pediatr Surg. 1997; 32:1241–1243.
17. Courcoutsakis N, Patronas N, Filie AC, Carney JA, Moraitis A, Stratakis CA. Ectopic thymus presenting as a thyroid nodule in a patient with the Carney complex. Thyroid. 2009; 19:293–296.
18. Han BK, Suh YL, Yoon HK. Thymic ultrasound. I. Intrathymic anatomy in infants. Pediatr Radiol. 2001; 31:474–479.
19. Park SH, Ryu CW, Kim GY, Shim KS. Intrathyroidal thymic tissue mimicking a malignant thyroid nodule in a 4-year-old child. Ultrasonography. 2014; 33:71–73.
20. Patel MN, Komlos M, Racadio JM. Intrathyroidal thymic tissue mimicking a thyroid nodule in a 4-year-old child. J Clin Ultrasound. 2013; 41:319–320.
21. Aguayo-Figueroa L, Golightly MG, Hu Y, Cohen HL, Wilson TA. Cytology and flow cytometry to identify ectopic thymic tissue masquerading as a thyroid nodule in two children. Thyroid. 2009; 19:403–406.
22. Gupta A, Ly S, Castroneves LA, Frates MC, Benson CB, Feldman HA, et al. A standardized assessment of thyroid nodules in children confirms higher cancer prevalence than in adults. J Clin Endocrinol Metab. 2013; 98:3238–3245.
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