Kostopoulou Eirini, Koliofoti Eleana Georgia, Spilioti Diamantina X, Miliordos Konstantinos, Skiadopoulos Spyros, Gil Andrea Paola Rojas, Fouzas Sotirios, Sinopidis Xenophon, Spiliotis Bessie E
Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, School of Medicine, University of Patras, 26504 Patras, Greece.
Department of Pediatrics, School of Medicine, University of Patras, 26504 Patras, Greece.
Diagnostics (Basel). 2024 Jul 15;14(14):1528. doi: 10.3390/diagnostics14141528.
Pediatric thyroid nodules (TNs) present a higher malignancy rate compared to adults. We sought to diagnose the frequency and characteristics of TNs in children and adolescents with subclinical hypothyroidism (SH) and their outcomes after levothyroxine (LT4) therapy. A total of 256 children with TNs and SH were followed every semester from 2006 to 2018. All patients were treated with LT4. Clinical and radiologic findings, such as the size and texture of the nodules, were documented. Analysis included one-way ANOVA, Kruskal-Wallis, Chi-square, and Fisher's exact tests. After initial LT4 therapy, TNs disappeared in 85.5% and did not reappear throughout follow-up. In 14.5%, TNs remained the same or increased in size, but they decreased after subsequent LT4 administration with an increased dose. Thyroid disease family history (FHTD) was documented in 77.0%. In total, 64.5% developed a goiter, 46.0% exhibited thyroid heterogeneity on ultrasound, 23.4% had positive Anti-Tg, and 25.4% had positive anti-TPO autoantibodies. Our findings support the possible premise that early pharmacologic intervention with LT4 may be beneficial in children and adolescents with TNs and SH. The increased frequency of FHTD, goiter, thyroid heterogeneity, and Hashimoto in our patients emphasizes that thyroid ultrasounds may be warranted in children and adolescents with these characteristics in order to rule out the presence of TNs.
与成人相比，小儿甲状腺结节（TNs）的恶性率更高。我们试图诊断亚临床甲状腺功能减退症（SH）患儿及青少年中TNs的发生率、特征及其左甲状腺素（LT4）治疗后的结果。2006年至2018年期间，每学期对256例患有TNs和SH的儿童进行随访。所有患者均接受LT4治疗。记录临床和影像学检查结果，如结节的大小和质地。分析包括单因素方差分析、Kruskal-Wallis检验、卡方检验和Fisher精确检验。初始LT4治疗后，85.5%的TNs消失，且在整个随访期间未复发。14.5%的TNs大小保持不变或增大，但在随后增加剂量的LT4给药后减小。77.0%的患者有甲状腺疾病家族史（FHTD）。总体而言，64.5%出现甲状腺肿大，46.0%超声显示甲状腺异质性，23.4%抗Tg阳性，25.4%抗甲状腺过氧化物酶自身抗体阳性。我们的研究结果支持这样一个可能的前提，即对患有TNs和SH的儿童及青少年进行早期药物干预（LT4）可能有益。我们患者中FHTD、甲状腺肿大、甲状腺异质性和桥本氏病的发生率增加，强调对于具有这些特征的儿童及青少年，可能有必要进行甲状腺超声检查以排除TNs的存在。
