BACKGROUND Thyroid nodules (TN) are detected in a small number of asymptomatic children and adolescents but are more frequently malignant (22-26%) than in adults leading some clinicians to perform thyroid ultrasound (US) for all children with goiter or autoimmune thyroiditis (AIT). Our study was designed to determine if suspicious clinical features predict the presence of TN in children with goiter or AIT so that US could be performed on those at highest risk. METHODS This was a retrospective review of 223 children and adolescents with goiter or AIT evaluated at a single institution. US was not performed on all patients. It is our practice to define glands that are large, firm, or nodular to palpation as "suspicious". Suspicious glands were interrogated by US and if TN was confirmed, this was further evaluated by fine-needle aspiration followed by surgery if indicated. RESULTS The median age was 12.9 years with 74.4% female. TN were confirmed by US in 16.6% of all patients but only 4.8% of those with AIT. By univariate analysis, TN were more common in those with family history of TN or differentiated thyroid carcinoma (DTC), thyroid asymmetry, and lower thyrotropin (TSH) levels. Differentiated thyroid carcinoma (DTC) was identified in 10.8% of TN and 1.8% of all patients. Firmness was significantly more common in patients with DTC (p = 0.0013). CONCLUSION TN were less common in those with AIT than reported in previous studies, suggesting that clinical features might fail to identify the majority of TN in patients with AIT. However, patients with asymmetric thyroid and a family history of TN or DTC have greatest risk for TN.

中文翻译：

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临床特征可能有助于确定患甲状腺结节风险最大的儿童和青少年。

背景技术在少数无症状的儿童和青少年中检出甲状腺结节（TN），但其恶性程度更高（22-26％），这比成人更常见，导致一些临床医生对所有患有甲状腺肿或自身免疫性甲状腺炎的儿童进行甲状腺超声检查（US）（ AIT）。我们的研究旨在确定可疑的临床特征是否可以预测甲状腺肿或AIT患儿中TN的存在，以便对高危人群进行US检查。方法这是一项回顾性研究，评估了在单个机构中评估的223名甲状腺肿或AIT患儿。并非对所有患者均进行US检查。我们的做法是将触诊较大，结实或结节的腺体定义为“可疑”。美国对可疑腺体进行了讯问，如果确定了TN，如果需要，可以通过细针抽吸和手术进一步评估。结果中位年龄为12.9岁，女性为74.4％。在所有患者中，经US确诊为TN的患者占16.6％，但只有AIT患者的占4.8％。通过单因素分析，TN在具有TN家族病史或分化型甲状腺癌（DTC），甲状腺不对称和较低促甲状腺激素（TSH）水平的患者中更为常见。在TN的10.8％和所有患者的1.8％中鉴别出了分化型甲状腺癌（DTC）。坚韧性在DTC患者中更为常见（p = 0.0013）。结论TN在AIT患者中不如以前的研究报道的那么普遍，这表明临床特征可能无法识别AIT患者中的大部分TN。但是，甲状腺不对称且有TN或DTC家族史的患者发生TN的风险最高。