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Nodular goiter in children
Medical expert of the article
Last reviewed: 05.07.2025
Nodular goiter is rarely diagnosed in children. Benign lesions that manifest as single nodes in the thyroid gland include benign adenoma, lymphocytic thyroiditis, thyroglossal duct cyst, ectopically located normal thyroid tissue, agenesis of one of the thyroid lobes with collateral hypertrophy, thyroid cyst, and abscess.
However, 15% of nodular formations are malignant.
[ Causes of nodular goiter
The causes of thyroid cancer development remain unclear. In most patients, regardless of age, cancer occurs against the background of nodular goiter, and in childhood, malignant degeneration of nodular goiter occurs more often than in adults.
Thyroid cancer in children is observed between the ages of 6 and 14. Papillary carcinoma develops most often. The second most common form of thyroid cancer in children is follicular carcinoma. The tumor develops slowly, but metastases appear early. Unlike adults, the first symptoms of the disease may be metastases in regional lymph nodes. The blood picture changes little even with a long-term 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 nodular goiter
Detection of a thyroid nodule is an indication for scanning it. Most malignant nodules are "cold" (have a reduced ability to concentrate a radionuclide substance), but not all "cold" nodules are malignant. Early diagnosis of thyroid cancer in children is difficult. In addition to scintigraphy and echography, fine-needle aspiration biopsy is indicated if malignancy is suspected. It is considered the only preoperative method that allows assessing structural changes and determining the cytological characteristics of a thyroid nodule. MRI allows one to judge the degree of infiltration into surrounding tissues. More often, the diagnosis is made only after histological examination of the removed goiter. A marker of medullary thyroid cancer is an increase in the content of calcitonin in the blood.
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Treatment of nodular goiter
If malignant or suspicious (follicular tumor) changes or a node with clinical and anamnestic signs of malignant growth are detected (using fine-needle aspiration biopsy), surgical treatment is indicated. Indications for immediate surgical treatment are a hard or rapidly growing node, signs of damage to the trachea or vocal cords, and enlargement of adjacent lymph nodes. Along with surgical treatment, radiation therapy, treatment with radioactive iodine, and hormone replacement therapy with sodium levothyroxine are performed. If there is absolute certainty that the node is benign, dynamic observation 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 nodular formation. Benign nodes have a favorable prognosis. The prognosis for papillary cancer depends on the size of the tumor. Ten-year survival is 80-95%. Follicular cancer has a more aggressive clinical course and metastasizes more often, which determines a less favorable prognosis than for papillary cancer. The prognosis for life with undifferentiated cancer is unfavorable.