Nódulos tireoidianos em crianças e adolescentes com hipotireoidismo congênito e tireoide eutópica

Abstract

Introduction: Thyroid nodules are rare in children when compared to adults. However, chances of malignancy are greater. Objective: To evaluate the laboratorial, image, and etiology characteristics of thyroid nodules in children and adolescents with congenital hypothyroidism (CH) with thyroid in situ. Methods: Retrospective cohort study. We evaluated 9 patients with CH, with thyroid in situ who development thyroid nodules during childhood or adolescence. Thyroid ultrasound, scintigraphy, and perchlorate discharge tests were conducted for CH etiologic diagnosis.Variables: gender, age at nodule diagnosis, number, location, and nodules characteristics obtained through ultrasound, cytological evaluation by FNAP and histological evaluation. Results: There was predominance of females. Etiologic diagnosis of CH was made in 7patients, of whom 5 (71,43%) showed a defect of iodine organification and 2 (28,55%) an unspecified defect of hormone synthesis. Average age at nodules diagnosis was 11,9 years. Ultrasound showed a solitary nodule in 3 of them (33,33%) and multiple nodules in 6 of them(66,67%). FNAP in 4 (57.14%) of the patients showed benign characteristics, malign characteristics in 2 (28,57%), and was unsatisfactory in 1 (14,28%). Thyroidectomy was performed in 4 (44,44%), of whom, 1 had follicular adenoma and 3 (33,33%) were diagnosed with carcinoma: 2 papillary and 1 follicular and micropapillar carcinoma. Conclusion: Higher frequency in females. CH by dyshormonogenesis proved to be a risk factor on the development of nodules. Wide range of TSH, reaching very high values, whichmay be a risk factor. US and FNAP are keys in the diagnosis of nodules by aiding differentiation between benign and malignant. Thyroidectomy was performed in 4 patients; 3 through US, FNAP and consistent histology and 1 through US and FNAP suggesting benignancy and malignancy histology. The higher frequency of papillary carcinoma wasdifferent from other studies with CH patients description.