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Nodular goiter in children
Medical expert of the article
Last reviewed: 23.04.2024
Nodular goiter in children is rarely diagnosed. Among benign lesions manifested as single nodes in the thyroid gland, benign adenoma, lymphocytic thyroiditis, cyst of the thyroid duct, ectopically located normal thyroid tissue, agenesis of one of the thyroid glands with collateral hypertrophy, thyroid cyst and abscess belong to the thyroid gland.
At the same time, 15% of the nodal formations are malignant.
[Causes of nodular goiter
The reasons for the development of thyroid cancer remain unclear. In most patients, regardless of age, cancer occurs against the background of nodular goiter, while in childhood, malignant degeneration of nodular goiter occurs more often than in adults.
Thyroid cancer in children is observed at the age of 6 to 14 years. The papillary carcinoma develops more often. The second most common type of thyroid cancer in children is follicular carcinoma. The tumor develops slowly, but the metastases appear early. Unlike adults, the first symptoms of the disease can be metastases in regional lymph nodes. The picture of the blood changes little even with a long-term current disease. Thyroid function often does not change or there is hypothyroidism. Less than 10% of thyroid cancer in children is medullary and undifferentiated.
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Diagnosis of nodal goiter
Detection of the node in the thyroid gland serves as an indication for its scanning. Most malignant nodes are "cold" (have a reduced ability to concentrate a radionuclide substance), but not all "cold" nodes are malignant. Early diagnosis of thyroid cancer in children is difficult. In addition to scintigraphy and ultrasound, if a malignancy is suspected, a fine needle aspiration biopsy is indicated. It is considered to be the only pre-operative method that allows assessing structural changes and determining the cytological characteristics of the thyroid nodule. MRI allows you to judge the degree of infiltration into surrounding tissues. More often the diagnosis is put only after a histological examination of a distant goiter. The marker of medullary thyroid cancer is an increase in calcitonin in the blood.
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Treatment of nodular goiter
When a malignant or suspicious (follicular tumor) changes or a node with clinical and anamnestic signs of malignant growth are detected (with fine needle aspiration biopsy), surgical treatment is indicated. Indication for immediate surgical treatment is a hard or fast growing node, signs of trachea or vocal cord injury, an increase in adjacent lymph nodes. Along with surgical treatment, radiotherapy, radioactive iodine treatment, hormone replacement therapy with levothyroxine sodium are carried out. With absolute confidence in the goodness of the node, dynamic monitoring with control (fine needle aspiration biopsy) is possible.
Prognosis of nodular goiter
The prognosis of nodular goiter is determined by the histological picture of the nodal formation. Benign nodes have a favorable prognosis. The prognosis for papillary cancer depends on the size of the tumor. The ten-year survival rate is 80-95%. Follicular cancer has a more aggressive clinical course and often metastasizes, which determines a less favorable prognosis than with papillary cancer. The prognosis for life with undifferentiated cancer is unfavorable.