Thyroid nodules and carcinoma

Thyroid nodules in children are rare: cancer is detected in up to 25 % of cases and is usually well differentiated. The diagnostic approach is based on a first-step clinical, laboratory, and sonographic evaluation. Patient and family history, clinical exam, and thyroid ultrasound provide diagnostic clues and are used to estimate the risk of malignancy to decide to proceed to further evaluation by fine-needle aspiration biopsy (FNAB), the gold standard to select nodule candidates for surgery. It is important to discriminate benign and malignant lesions preoperatively as in the latter case total thyroidectomy is indicated, with neck lymph node dissection in some circumstances. Thyroid scintiscan is almost only used in the rare cases of hyperthyroidism, aiming at confirming the diagnosis of adenoma. In spite of the lack of data in pediatric age due to the rarity of the disease, this review tries to summarize the evidence on diagnosis and treatment of thyroid nodules in childhood, critically reviewing adult guidelines and commenting on the most recent and promising diagnostic techniques and therapeutic options in the field.