Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea.
Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
Clin Endocrinol (Oxf). 2021 Oct;95(4):638-648. doi: 10.1111/cen.14490. Epub 2021 Jun 11.
We evaluated the frequency, risk factors and the follow-up outcomes of thyroid nodules, and genetic alterations in thyroid cancer, in youth with childhood-onset Hashimoto thyroiditis (HT) residing in an iodine-sufficient country.
A retrospective cohort study.
A total of 213 patients (194 females, mean age 10.6 years at the time of HT diagnosis) were ultrasonographically evaluated. Thyroid nodules were categorized using the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and the American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TI-RADS).
Thyroid nodules were detected in 40 (18.8%) patients over a median follow-up period of 3.4 years, usually after the onset of puberty. A family history of thyroid disease (hazard ratio 2.1, p = .031) was predictive of thyroid nodule detection. Papillary thyroid carcinoma (PTC) was diagnosed in 9 (4.2% of all and 22.5% of nodule-positive patients). The malignant nodules had a higher K-TIRADS or ACR-TI-RADS risk level compared with benign nodules (p < .01 for both). Genetic alterations were revealed in 7 (BRAF in 6 and RET-ERC1 fusion in 1) of the eight available tumour tissue samples. None showed evidence of disease over a median follow-up period of 3.4 years.
The nodule detection rate was 18.8%, with a 22.5% risk of malignancy among the detected nodules in childhood-onset HT patients, showing increased risk in those with a family history. Additional large-scale studies are required to evaluate the usefulness of K-TIRADS or ACR-TI-RADS risk level for the differentiation of paediatric thyroid nodules.
我们评估了生活在碘充足国家的儿童期起病桥本甲状腺炎（HT）患者中甲状腺结节的发生频率、危险因素和随访结局，以及甲状腺癌的遗传改变。
回顾性队列研究。
共有 213 名患者（194 名女性，HT 诊断时的平均年龄为 10.6 岁）进行了超声评估。甲状腺结节使用韩国甲状腺影像报告和数据系统（K-TIRADS）和美国放射学院甲状腺影像报告和数据系统（ACR-TI-RADS）进行分类。
在中位随访 3.4 年期间，40 名（18.8%）患者发现甲状腺结节，通常在青春期后出现。甲状腺疾病家族史（风险比 2.1，p =.031）是发现甲状腺结节的预测因素。诊断出 9 例（所有患者的 4.2%和结节阳性患者的 22.5%）甲状腺乳头状癌（PTC）。恶性结节的 K-TIRADS 或 ACR-TI-RADS 风险水平高于良性结节（均 p <.01）。在 8 个可获得肿瘤组织样本中，有 7 个（6 个 BRAF 和 1 个 RET-ERC1 融合）显示出基因改变。在中位随访 3.4 年期间，均无疾病证据。
在儿童期起病 HT 患者中，结节检出率为 18.8%，检出结节中恶性结节的风险为 22.5%，有家族史者风险增加。需要开展更多的大型研究来评估 K-TIRADS 或 ACR-TI-RADS 风险水平对小儿甲状腺结节的鉴别诊断的有用性。
