Book Chapter10.1007/978-3-662-67631-8_5
Thyroid
Barry L. Shulkin,Thomas N.B. Pascual +1 more
- 01 Jan 2023
- pp 57-74
TL;DR: Thyroid imaging is used to diagnose and monitor thyroid diseases in children. It is commonly used in conjunction with other clinical tests and imaging modalities. Thyroid cancer is the most common endocrine malignancy in children.
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Abstract: Abstract Thyroid imaging, one of the earliest scanning tests, is used in children to determine the cause of congenital and acquired thyroid diseases. It should be interpreted in conjunction with the patient’s clinical picture, thyroid function tests, history of medication and diet, physical examination, thyroid function tests, and ultrasound. Congenital hypothyroidism (CHT) is usually detected on newborn screening. Ectopic thyroid and thyroid aplasia may result in hypothyroidism requiring lifelong hormone replacement therapy. In the presence of a normally positioned, fully developed thyroid, CHT can be transient. Evaluation of acquired benign thyroid disease in children is occasionally supplemented by radioactive iodine uptake tests and can be an aid in therapeutic decisions. Thyroid cancer is the most common endocrine malignancy in children and represents up to 2% of all cancers diagnosed by the age of 20 years, more common in teenagers. It is diagnosed in 25% of thyroid nodules in children, as compared to 10–15% in adults. Children with thyroid cancer present with more advanced disease than adults, including multifocal primary and a higher incidence of regional and distant metastases. Cervical lymph node metastases are diagnosed in 50% and lung metastases in 20% of cases. 131 I, a suboptimal agent for imaging, has been largely replaced by 123 I and 99m Tc-pertechnetate. 131 I is at present used mainly for therapeutic purposes in hyperthyroidism, ablation of thyroid remnants following thyroidectomy, and for treatment of thyroid cancer.
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Figures
Fig. 5.4 History: Neonate with congenital hypothyroidism. Study report: There is high Pertechnetate uptake of 13.6% (normal range: 0.45–4%) in a normally located thyroid gland (left-lateral, right-anterior view) showing the usual butterfly shape. Impression: The findings are compatible with dyshormonogenesis 
Fig. 5.6 History: A 16-year-old girl complained of fatigue, weakness and headaches for several months. Her lab results showed low TSH levels, normal FT4 and mildly elevated T3. Physical examination revealed a nodule in the right thyroid lobe. Neck US demonstrated a 2.7 × 1.5 cm solid nodule in the lower pole of the right thyroid lobe. Study report: A Pertechnetate thyroid scan, anterior view with a parallel-hole collimator (left) and anterior pinhole image (right) show intense tracer uptake 
Fig. 5.7 History: A 9-year-old girl had a right thyroid lobe resection followed by complete thyroidectomy for follicular thyroid cancer. Study report: on the post-surgery 123I thyroid scan (a) there are RAI-avid foci with 3% residual tracer uptake in the neck, more in the left lobe of the thyroid. Repeat surgery was performed only on the left side neck because of a significant amount of scar tissue on the right side. The patient then received a 1110 MBq 
Fig. 5.8 History: A 6-year-old girl presented with a rightsided neck mass and underwent thyroidectomy. A 4-cm papillary carcinoma with extrathyroidal extension and lymph node involvement was found. Study report: The 123I post-thyroidectomy scan (a, whole-body anterior and posterior views, b, pinhole images of the neck) revealed several foci of remnant thyroid tissue in the neck as well as a focal area of tracer uptake in a left lung nodule as demonstrated on SPECT/CT (c), consistent with a RAI-avid left lung metastasis. The patient received a therapeutic dose of 
Fig. 5.1 History: Neonate with congenital hypothyroidism. Study report: In the left lateral view (right, with, and left, without markers), there is no evidence of functioning thyroid tissue in the neck or elsewhere. Impression: The findings are compatible with thyroid agenesis or a severely dysplastic thyroid 
Fig. 5.3 History: Neonate with congenital hypothyroidism. Study report: Following administration of Pertechnetate, on the left lateral view (left, without markers) there are two foci of tracer uptake behind the tongue. No tracer uptake is seen in the physiologic thyroid loca-
References
Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer
Gary L. Francis,Steven G. Waguespack,Andrew J. Bauer,Peter Angelos,Salvatore Benvenga,Janete M. Cerutti,Catherine A. Dinauer,Jill Hamilton,Ian D. Hay,Markus Luster,Marguerite T. Parisi,Marianna Rachmiel,Geoffrey B. Thompson,Shunichi Yamashita +13 more
TL;DR: These inaugural guidelines provide recommendations for the evaluation and management of thyroid nodules in children and adolescents, including the role and interpretation of ultrasound, fine-needle aspiration cytology, and the management of benign nodules.
Update of Newborn Screening and Therapy for Congenital Hypothyroidism
Susan R. Rose,Rosalind S. Brown +1 more
TL;DR: Efforts are ongoing to establish the optimal therapy that leads to maximum potential for normal development for infants with congenital hypothyroidism, as well as to maintain frequent evaluations of total Thyroxine or free thyroxine in the upper half of the reference range during the first 3 years of life.
European Society for Paediatric Endocrinology consensus guidelines on screening, diagnosis, and management of congenital hypothyroidism.
Juliane Léger,Antonella Olivieri,Malcolm Donaldson,Toni Torresani,Heiko Krude,Guy Van Vliet,Michel Polak,Gary Butler +7 more
TL;DR: In this paper, a systematic literature search was conducted to identify key articles relating to the screening, diagnosis, and management of congenital hypothyroidism (CH) and the evidence-based guidelines were developed with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system, describing both the strength of recommendations and the quality of evidence.
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Congenital Hypothyroidism: A 2020–2021 Consensus Guidelines Update—An ENDO-European Reference Network Initiative Endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology
Paul van Trotsenburg,Athanasia Stoupa,Juliane Léger,Juliane Léger,Tilman R Rohrer,Catherine Peters,Laura Fugazzola,Alessandra Cassio,Claudine Heinrichs,Véronique Beauloye,Joachim Pohlenz,Patrice Rodien,Régis Coutant,Gabor Szinnai,Philip Murray,Beate Bartés,Dominique Luton,Mariacarolina Salerno,Luisa de Sanctis,Mariacristina Vigone,Heiko Krude,Luca Persani,Michel Polak +22 more
TL;DR: This consensus guidelines update should be used to further optimize detection, diagnosis, treatment, and follow-up of children with all forms of congenital hypothyroidism in the light of the most recent evidence.
A Standardized Assessment of Thyroid Nodules in Children Confirms Higher Cancer Prevalence Than in Adults
Anjuli Gupta,Samantha Ly,Luciana A. Castroneves,Mary C. Frates,Carol B. Benson,Henry A. Feldman,Ari J. Wassner,Jessica Smith,Ellen Marqusee,Erik K. Alexander,Justine A. Barletta,Peter M. Doubilet,Hope E. Peters,Susan M. Webb,Biren P. Modi,Harriet J. Paltiel,Harry P.W. Kozakewich,Edmund S. Cibas,Francis D. Moore,Robert C. Shamberger,P. Reed Larsen,Stephen A. Huang +21 more
TL;DR: Although the relative cancer prevalence of sonographically confirmed nodules ≥ 1 cm is higher in pediatric patients than adults, most children referred for suspected nodules have benign conditions, and efforts to avoid unnecessary surgery in this majority are warranted.