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Pediatric thyroid ultrasound: a radiologist’s checklist

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Abstract

Ultrasonography (US) is the imaging method of choice for evaluating the pediatric thyroid gland, complemented by scintigraphy and thyroid function tests, especially when evaluating children with suspected congenital hypothyroidism, goiter, infectious or autoimmune diseases, or neoplasm. Diagnostic considerations in newborns with congenital hypothyroidism mainly include dysgenesis, dyshormonogenesis, transient hypothyroidism and central (hypophyseal) hypothyroidism. The midline of the neck should be scrutinized for thyroid tissue from the floor of the mouth to the thoracic inlet. Cystic and echogenic ultimobranchial remnants should not be misinterpreted as orthotopic thyroid tissue. Diffuse thyroid diseases affect older children; these comprise Hashimoto and Graves diseases and infectious thyroiditis and exhibit features similar to those in adults. It is important to note that the diffuse sclerosing variant of papillary thyroid cancer can complicate thyroiditis and should not be confused with Hashimoto disease. In children with solid nodules the threshold for fine-needle aspiration biopsy or surgery should be lower compared to adults because of a higher likelihood of malignancy compared with adults. Biopsy should be considered in nodules with suspicious ultrasonographic features, even when smaller than 1 cm. Adult classification systems of thyroid nodules, although useful, are not sufficient to safely discriminate the nodules’ likelihood of malignancy in children. We describe key sonographic findings and suggest a standard checklist that might be considered while performing and interpreting thyroid US in neonates and children.

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References

  1. Muirhead S (2001) Diagnostic approach to goitre in children. Paediatr Child Health 6:195–199

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Hong HS, Lee EH, Jeong SH et al (2015) Ultrasonography of various thyroid diseases in children and adolescents: a pictorial essay. Korean J Radiol 16:419–429

    PubMed  PubMed Central  Google Scholar 

  3. Williams JL, Paul DL, Bisset G 3rd (2013) Thyroid disease in children: part 1. Pediatr Radiol 43:1244–1253

    PubMed  Google Scholar 

  4. Babcock D (2016) Thyroid disease in the pediatric patient: emphasizing imaging with sonography. Pediatr Radiol 36:299–308

    Google Scholar 

  5. Chang YW, Hong HS, Choi DL (2009) Sonography of the pediatric thyroid: a pictorial essay. J Clin Ultrasound 37:149–157

    PubMed  Google Scholar 

  6. Goldis M, Waldman L, Marginean O et al (2016) Thyroid imaging in infants. Endocrinol Metab Clin N Am 45:255–266

    Google Scholar 

  7. Jones JH, Attaie M, Marroo S et al (2010) Heterogeneous tissue in the thyroid fossa on ultrasound in infants with proven thyroid ectopia on isotope scan — a diagnostic trap. Pediatr Radiol 40:725–731

    PubMed  Google Scholar 

  8. McQueen AS, Bhatia KS (2018) Head and neck ultrasound: technical advances, novel applications and the role of elastography. Clin Radiol 73:81–93

    CAS  PubMed  Google Scholar 

  9. Bakırtaş Palabıyık F, İnci E, Papatya Çakır ED, Hocaoğlu E (2019) Evaluation of normal thyroid tissue and autoimmune thyroiditis in children using shear wave elastography. J Clin Res Pediatr Endocrinol 28:132–139

    Google Scholar 

  10. Borysewicz-Sanczyk H, Dzieciol J, Sawicka B, Bossowski A (2016) Practical application of elastography in the diagnosis of thyroid nodules in children and adolescents. Horm Res Paediatr 86:39–44

    CAS  PubMed  Google Scholar 

  11. Aydıner Ö, Karakoç Aydıner E et al (2015) Normative data of thyroid volume — ultrasonographic evaluation of 422 subjects aged 0-55 years. J Clin Res Pediatr Endocrinol 7:98–101

    PubMed  PubMed Central  Google Scholar 

  12. Chanoine JP, Toppet V, Lagasse R et al (1991) Determination of thyroid volume by ultrasound from the neonatal period to late adolescence. Eur J Pediatr 150:395–399

    CAS  PubMed  Google Scholar 

  13. Taş F, Bulut S, Eğilmez H et al (2002) Normal thyroid volume by ultrasonography in healthy children. Ann Trop Paediatr 22:375–379

    PubMed  Google Scholar 

  14. Perry RJ, Hollman AS, Wood AM, Donaldson MD (2002) Ultrasound of the thyroid gland in the newborn: normative data. Arch Dis Child Fetal Neonatal Ed 87:F209–F211

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Ng SM, Turner MA, Avula S (2018) Ultrasound measurements of thyroid gland volume at 36 weeks' corrected gestational age in extremely preterm infants born before 28 weeks' gestation. Eur Thyroid J 7:21–26

    CAS  PubMed  Google Scholar 

  16. Zimmermann MB, Hess SY, Molinari L et al (2004) New reference values for thyroid volume by ultrasound in iodine-sufficient schoolchildren: a World Health Organization/Nutrition for Health and Development Iodine Deficiency Study Group report. Am J Clin Nutr 79:231–237

    CAS  PubMed  Google Scholar 

  17. Moradi M, Hashemipour M, Akbari S et al (2014) Ultrasonographic evaluation of the thyroid gland volume among 8–15-year-old children in Isfahan, Iran. Adv Biomed Res 3:9

    PubMed  PubMed Central  Google Scholar 

  18. Delange F, Benker G, Caron P et al (1997) Thyroid volume and urinary iodine in European schoolchildren: standardization of values for assessment of iodine deficiency. Eur J Endocrinol 136:180–187

    CAS  PubMed  Google Scholar 

  19. Zygmunt A (2015) Are the normal values of thyroid gland in children fulfilling the role attributed to them? Thyroid Res 8:A27

    PubMed Central  Google Scholar 

  20. Yasumoto M, Inoue H, Ohashi I et al (2004) Simple new technique for sonographic measurement of the thyroid in neonates and small children. J Clin Ultrasound 32:82–85

    PubMed  Google Scholar 

  21. Ruchała M, Szczepanek E, Sowiński J (2011) Diagnostic value of radionuclide scanning and ultrasonography in thyroid developmental anomaly imaging. Nucl Med Rev Cent East Eur 14:21–28

    PubMed  Google Scholar 

  22. Sedassari Ade A, de Souza LR, Sedassari Nde A et al (2015) Sonographic evaluation of children with congenital hypothyroidism. Radiol Bras 48:220–224

    PubMed  Google Scholar 

  23. Supakul N, Delaney LR, Siddiqui AR et al (2012) Ultrasound for primary imaging of congenital hypothyroidism. AJR Am J Roentgenol 199:W360–W366

    PubMed  Google Scholar 

  24. Bubuteishvili L, Garel C, Czernichow P, Léger J (2003) Thyroid abnormalities by ultrasonography in neonates with congenital hypothyroidism. J Pediatr 143:759–764

    PubMed  Google Scholar 

  25. Karakoc-Aydiner E, Turan S, Akpinar I et al (2012) Pitfalls in the diagnosis of thyroid dysgenesis by thyroid ultrasonography and scintigraphy. Eur J Endocrinol 166:43–48

    CAS  PubMed  Google Scholar 

  26. Korpal-Szczyrska M, Kosiak W, Swieton D (2008) Prevalence of thyroid hemiagenesis in an asymptomatic schoolchildren population. Thyroid 18:637–639

    PubMed  Google Scholar 

  27. Perry RJ, Maroo S, Maclennan AC et al (2006) Combined ultrasound and isotope scanning is more informative in the diagnosis of congenital hypothyroidism than single scanning. Arch Dis Child 91:972–976

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Gaudino R, Garel C, Czernichow P, Léger J (2005) Proportion of various types of thyroid disorders among newborns with congenital hypothyroidism and normally located gland: a regional cohort study. Clin Endocrinol 62:444–448

    Google Scholar 

  29. Ramos HE, Nesi-França S, Boldarine VT et al (2009) Clinical and molecular analysis of thyroid hypoplasia: a population-based approach in southern Brazil. Thyroid 19:61–68

    CAS  PubMed  Google Scholar 

  30. Ueda D, Yoto Y, Sato T (1998) Ultrasonic assessment of the lingual thyroid gland in children. Pediatr Radiol 28:126–128

    CAS  PubMed  Google Scholar 

  31. Hong HS, Lee JY, Jeong SH (2017) Thyroid disease in children and adolescents. Ultrasonography 36:286–291

    Google Scholar 

  32. Bagalkot PS, Parshwanath BA, Joshi SN (2013) Neck swelling in a newborn with congenital goiter. J Clin Neonatol 2:36–38

    PubMed  PubMed Central  Google Scholar 

  33. Pedersen OM, Aardal NP, Larssen TB et al (2000) The value of ultrasonography in predicting autoimmune thyroid disease. Thyroid 10:251–259

    CAS  PubMed  Google Scholar 

  34. Pearce EN, Farwell AP, Braverman LE (2003) Thyroiditis. N Engl J Med 26:2646–2655

    Google Scholar 

  35. Essenmacher AC, Joyce PH Jr, Kao SC et al (2017) Sonographic evaluation of pediatric thyroid nodules. Radiographics 37:1731–1752

    PubMed  Google Scholar 

  36. Penta L, Cofini M, Lanciotti L et al (2018) Hashimoto’s disease and thyroid cancer in children: are they associated? Front Endocrinol 9:565

    Google Scholar 

  37. Zois C, Stavrou I, Kalogera C et al (2003) High prevalence of autoimmune thyroiditis in schoolchildren after elimination of iodine deficiency in northwestern Greece. Thyroid 13:485–489

    PubMed  Google Scholar 

  38. Hanley P, Lord K, Bauer AJ (2016) Thyroid disorders in children and adolescents: a review. JAMA Pediatr 170:1008–1019

    PubMed  Google Scholar 

  39. Williams JL, Paul D, Bisset G 3rd (2013) Thyroid disease in children: part 2: state-of-the-art imaging in pediatric hyperthyroidism. Pediatr Radiol 43:1254–1264

    PubMed  Google Scholar 

  40. Vlachopapadopoulou E, Thomas D, Karachaliou F et al (2009) Evolution of sonographic appearance of the thyroid gland in children with Hashimoto's thyroiditis. J Pediatr Endocrinol Metab 22:339–344

    PubMed  Google Scholar 

  41. Cappa M, Bizzarri C, Crea F (2010) Autoimmune thyroid diseases in children. J Thyroid Res 2010:675703

    Google Scholar 

  42. Kangelaris GT, Kim TB, Orloff LA (2010) Role of ultrasound in thyroid disorders. Otolaryngol Clin N Am 43:1209–1227

    Google Scholar 

  43. Park S, Jeong JS, Ryu HR et al (2013) Differentiated thyroid carcinoma of children and adolescents: 27-year experience in the Yonsei University health system. J Korean Med Sci 28:693–699

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Kosiak W, Piskunowicz M, Świętoń D et al (2015) An additional ultrasonographic sign of Hashimoto's lymphocytic thyroiditis in children. J Ultrason 15:349–357

    PubMed  PubMed Central  Google Scholar 

  45. Koo JS, Hong S, Park CS (2009) Diffuse sclerosing variant is a major subtype of papillary thyroid carcinoma in the young. Thyroid 19:1225–1231

    PubMed  Google Scholar 

  46. Williamson S, Greene SA (2010) Incidence of thyrotoxicosis in childhood: a national population based study in the UK and Ireland. Clin Endocrinol 72:358–363

    Google Scholar 

  47. Lee SJ, Lim GY, Kim JY, Chung MH (2016) Diagnostic performance of thyroid ultrasonography screening in pediatric patients with a hypothyroid, hyperthyroid or euthyroid goiter. Pediatr Radiol 46:104–111

    PubMed  Google Scholar 

  48. Havgaard Kjær R, Smedegård Andersen M, Hansen D (2015) Increasing incidence of juvenile thyrotoxicosis in Denmark: a nationwide study, 1998-2012. Horm Res Paediatr 84:102–107

    PubMed  Google Scholar 

  49. Dunne C, De Luca F (2014) Long-term follow-up of a child with autoimmune thyroiditis and recurrent hyperthyroidism in the absence of TSH receptor antibodies. Case Rep Endocrinol 2014:749576

    PubMed  PubMed Central  Google Scholar 

  50. Son JK, Lee EY (2007) Acute suppurative thyroiditis. Pediatr Radiol 37:105

    PubMed  Google Scholar 

  51. Wang HK, Tiu CM, Chou YH, Chang CY (2003) Imaging studies of pyriform sinus fistula. Pediatr Radiol 33:328–333

    PubMed  Google Scholar 

  52. Parida PK, Gopalakrishnan S, Saxena SK (2014) Pediatric recurrent acute suppurative thyroiditis of third branchial arch origin — our experience in 17 cases. Int J Pediatr Otorhinolaryngol 78:1953–1957

    PubMed  Google Scholar 

  53. Park SY, Kim EK, Kim MJ et al (2006) Ultrasonographic characteristics of subacute granulomatous thyroiditis. Korean J Radiol 7:229–234

    PubMed  PubMed Central  Google Scholar 

  54. Avula S, Daneman A, Navarro OM et al (2010) Incidental thyroid abnormalities identified on neck US for non-thyroid disorders. Pediatr Radiol 40:1774–1780

    PubMed  Google Scholar 

  55. Naranjo ID, Robinot DC, Rojo JC, Ponferrada MR (2016) Polycystic thyroid disease in pediatric patients: an uncommon cause of hypothyroidism. J Ultrasound Med 35:209–211

    PubMed  Google Scholar 

  56. Raissaki M, Tritou I, Smirnaki P (2018) Sonographic appearances of intrathyroid thymus: emphasis on details. Hell J Radiol 3:42–51

    Google Scholar 

  57. Moudgil P, Vellody R, Heider A et al (2016) Ultrasound-guided fine-needle aspiration biopsy of pediatric thyroid nodules. Pediatr Radiol 46:365–371

    PubMed  Google Scholar 

  58. Mortensen C, Lockyer H, Loveday E (2014) The incidence and morphological features of pyramidal lobe on thyroid ultrasound. Ultrasound 22:192–198

    CAS  PubMed  PubMed Central  Google Scholar 

  59. Donohoo JH, Wallach MT (2006) Cricoid cartilage on sonography in pediatric patients mimics a thyroid mass. J Ultrasound Med 25:907–911

    PubMed  Google Scholar 

  60. Strauss S (2000) Sonographic appearance of cricoid cartilage calcification in healthy children. AJR Am J Roentgenol 174:223–228

    CAS  PubMed  Google Scholar 

  61. Creo A, Alahdab F, Al Nofal A et al (2018) Ultrasonography and the American Thyroid Association ultrasound-based risk stratification tool: utility in pediatric and adolescent thyroid nodules. Horm Res Paediatr 90:93–101

    CAS  PubMed  Google Scholar 

  62. Francis GL, Waguespack SG, Bauer AJ et al (2015) Management guidelines for children with thyroid nodules and differentiated thyroid cancer. Thyroid 25:716–759

    PubMed  PubMed Central  Google Scholar 

  63. Richman DM, Benson CB, Doubilet PM et al (2018) Thyroid nodules in pediatric patients: sonographic characteristics and likelihood of cancer. Radiology 288:591–599

    PubMed  PubMed Central  Google Scholar 

  64. LaFranchi SH (2015) Inaugural management guidelines for children with thyroid nodules and differentiated thyroid cancer: children are not small adults. Thyroid 25:713–715

    PubMed  Google Scholar 

  65. Holmqvist AS, Chen Y, Berano Teh J et al (2019) Risk of solid subsequent malignant neoplasms after childhood Hodgkin lymphoma — identification of high-risk populations to guide surveillance: a report from the late effects study group. Cancer 125:1373–1383

    CAS  PubMed  Google Scholar 

  66. Lim-Dunham JE, Toslak IE, Reiter MP, Martin B (2019) Assessment of the American College of Radiology thyroid imaging reporting and data system for thyroid nodule malignancy risk stratification in a pediatric population. AJR Am J Roentgenol 212:1–7

    Google Scholar 

  67. Ogle S, Merz A, Parina R et al (2018) Ultrasound and evaluation of pediatric thyroid malignancy. J Ultrasound Med 37:2311–2324

    PubMed  Google Scholar 

  68. Lim-Dunham JE (2019) Ultrasound guidelines for pediatric thyroid nodules: proceeding with caution. Pediatr Radiol 49:851–853

    PubMed  Google Scholar 

  69. Lim-Dunham JE, Erdem Toslak I, Alsabban K et al (2017) Ultrasound risk stratification for malignancy using the 2015 American Thyroid Association management guidelines for children with thyroid nodules and differentiated thyroid cancer. Pediatr Radiol 47:429–436

    PubMed  Google Scholar 

  70. Martinez-Rios C, Daneman A, Bajno L et al (2018) Utility of adult-based ultrasound malignancy risk stratifications in pediatric thyroid nodules. Pediatr Radiol 48:74–84

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Venizeleion General Hospital of Heraklion, Crete, Greece

    Ioanna Tritou & Kalliroi Kalaitzaki

  2. Children’s Hospital P&A Kyriakou, Athens, Greece

    Marina Vakaki & Rodanthi Sfakiotaki

  3. Radiology Department, University Hospital of Heraklion, Medical School, University of Crete, Stavrakia Voutes, 71110, Crete, Greece

    Maria Raissaki

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  1. Ioanna Tritou
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  2. Marina Vakaki
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  3. Rodanthi Sfakiotaki
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Correspondence to Maria Raissaki.

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Tritou, I., Vakaki, M., Sfakiotaki, R. et al. Pediatric thyroid ultrasound: a radiologist’s checklist. Pediatr Radiol 50, 563–574 (2020). https://doi.org/10.1007/s00247-019-04602-2

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