甲状腺肿大儿童和青少年甲状腺的超声特征：单中心经验
Ultrasound characteristics of the thyroid in children and adolescents with goiter: a single center experience.
作者信息
Kambalapalli Mamatha, Gupta Anshu, Prasad Uma R, Francis Gary L
机构信息
1 Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University , Richmond, Virginia.
出版信息
Thyroid. 2015 Feb;25(2):176-82. doi: 10.1089/thy.2014.0161. Epub 2014 Dec 17.
INTRODUCTION
Autoimmune thyroiditis (AIT) is a common cause of goiter in children, and sonographic changes have been reported in more than one-third at presentation. The aim of this study was to evaluate the ultrasound (US) characteristics of the thyroid and the prevalence of thyroid nodules in children and adolescents presenting with goiter in the presence or absence of AIT.
METHODS
A retrospective review was conducted of the US characteristics of 154 children and adolescents aged <18 years of age with goiter from July 2008 to December 2010. US characteristics were analyzed according to each patient's age, sex, thyrotropin (TSH) levels, and thyroid peroxidase antibody titer (TPOAb). Heterogeneity and nodule prevalence were compared between antibody-positive and -negative goiter.
RESULTS
Heterogeneity was more common in TPOAb-positive (59/71, 83%) compared to TPOAb-negative goiter (24/46, 52%; p<0.001), but there was no correlation between the presence of heterogeneity and TPOAb titer within the antibody-positive group. Nodules were equally prevalent in children with (17%) and without (17.4%) TPOAb, and there was no correlation between the serum TSH level or TPOAb titer and the presence of nodules. Papillary thyroid cancer (PTC) was diagnosed in 3/71 with positive TPOAb compared to 1/46 with negative antibodies. Pseudonodules were identified in 11/71 antibody-positive and none of the antibody-negative patients. However, during follow-up, two of these were later identified as nodules and one was PTC.
CONCLUSION
The majority of children and adolescents with goiter had positive TPOAb (71/117). Sonographic heterogeneity was more common among TPOAb-positive patients. However, thyroid nodules and PTC were equally common in both groups. Only 15% of the nodules and none of the PTC were palpable. These data support the utility of thyroid US to detect unsuspected thyroid nodules and PTC in children with goiter. Prospective follow-up studies of children with goiter are needed to formulate recommendations for evaluation with US and fine-needle aspiration.
引言
自身免疫性甲状腺炎（AIT）是儿童甲状腺肿大的常见原因，超过三分之一的患者在就诊时已有超声改变。本研究旨在评估甲状腺肿大的儿童和青少年在有无AIT情况下甲状腺的超声（US）特征及甲状腺结节的患病率。
方法
对2008年7月至2010年12月期间154例年龄小于18岁的甲状腺肿大儿童和青少年的US特征进行回顾性分析。根据每位患者的年龄、性别、促甲状腺激素（TSH）水平和甲状腺过氧化物酶抗体滴度（TPOAb）分析US特征。比较抗体阳性和阴性甲状腺肿大之间的异质性和结节患病率。
结果
与TPOAb阴性的甲状腺肿大（24/46，52%；p<0.001）相比，TPOAb阳性的甲状腺肿大（59/71，83%）中异质性更为常见，但在抗体阳性组中，异质性的存在与TPOAb滴度之间无相关性。TPOAb阳性（17%）和阴性（17.4%）的儿童中结节患病率相同，血清TSH水平或TPOAb滴度与结节的存在之间无相关性。TPOAb阳性的71例中有3例诊断为甲状腺乳头状癌（PTC），抗体阴性的46例中有1例。11/71例抗体阳性患者中发现假结节，抗体阴性患者中未发现假结节。然而，在随访过程中，其中2例后来被确定为结节，1例为PTC。
结论
大多数甲状腺肿大的儿童和青少年TPOAb呈阳性（71/117）。超声异质性在TPOAb阳性患者中更为常见。然而，两组中甲状腺结节和PTC的发生率相同。只有15%的结节可触及，PTC均不可触及。这些数据支持甲状腺超声在检测甲状腺肿大儿童中未被怀疑的甲状腺结节和PTC方面的实用性。需要对甲状腺肿大儿童进行前瞻性随访研究，以制定超声评估和细针穿刺的建议。
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