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Kostopoulou E, Koliofoti EG, Spilioti DX, Miliordos K, Skiadopoulos S, Gil APR, Fouzas S, Sinopidis X, Spiliotis BE. Diagnosis of Thyroid Nodules in Children and Adolescents with Subclinical Hypothyroidism and Their Outcomes after Early Thyroxine Treatment-A Longitudinal Study. Diagnostics (Basel) 2024; 14:1528. [PMID: 39061665 PMCID: PMC11275568 DOI: 10.3390/diagnostics14141528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/01/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Pediatric thyroid nodules (TNs) present a higher malignancy rate compared to adults. We sought to diagnose the frequency and characteristics of TNs in children and adolescents with subclinical hypothyroidism (SH) and their outcomes after levothyroxine (LT4) therapy. A total of 256 children with TNs and SH were followed every semester from 2006 to 2018. All patients were treated with LT4. Clinical and radiologic findings, such as the size and texture of the nodules, were documented. Analysis included one-way ANOVA, Kruskal-Wallis, Chi-square, and Fisher's exact tests. After initial LT4 therapy, TNs disappeared in 85.5% and did not reappear throughout follow-up. In 14.5%, TNs remained the same or increased in size, but they decreased after subsequent LT4 administration with an increased dose. Thyroid disease family history (FHTD) was documented in 77.0%. In total, 64.5% developed a goiter, 46.0% exhibited thyroid heterogeneity on ultrasound, 23.4% had positive Anti-Tg, and 25.4% had positive anti-TPO autoantibodies. Our findings support the possible premise that early pharmacologic intervention with LT4 may be beneficial in children and adolescents with TNs and SH. The increased frequency of FHTD, goiter, thyroid heterogeneity, and Hashimoto in our patients emphasizes that thyroid ultrasounds may be warranted in children and adolescents with these characteristics in order to rule out the presence of TNs.
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Affiliation(s)
- Eirini Kostopoulou
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, School of Medicine, University of Patras, 26504 Patras, Greece; (E.K.); (E.G.K.); (D.X.S.); (A.P.R.G.); (B.E.S.)
| | - Eleana Georgia Koliofoti
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, School of Medicine, University of Patras, 26504 Patras, Greece; (E.K.); (E.G.K.); (D.X.S.); (A.P.R.G.); (B.E.S.)
| | - Diamantina X. Spilioti
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, School of Medicine, University of Patras, 26504 Patras, Greece; (E.K.); (E.G.K.); (D.X.S.); (A.P.R.G.); (B.E.S.)
| | - Konstantinos Miliordos
- Department of Pediatrics, School of Medicine, University of Patras, 26504 Patras, Greece; (K.M.); (S.F.)
| | - Spyros Skiadopoulos
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece;
| | - Andrea Paola Rojas Gil
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, School of Medicine, University of Patras, 26504 Patras, Greece; (E.K.); (E.G.K.); (D.X.S.); (A.P.R.G.); (B.E.S.)
- Laboratory of Basic Health Sciences, Department of Nursing, Faculty of Health Sciences, University of Peloponnese, 22100 Tripoli, Greece
| | - Sotirios Fouzas
- Department of Pediatrics, School of Medicine, University of Patras, 26504 Patras, Greece; (K.M.); (S.F.)
| | - Xenophon Sinopidis
- Department of Pediatric Surgery, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Bessie E. Spiliotis
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, School of Medicine, University of Patras, 26504 Patras, Greece; (E.K.); (E.G.K.); (D.X.S.); (A.P.R.G.); (B.E.S.)
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Shi W, Cai W, Wang S, Gao Y, Yang R, Liu Q, Liu Y, Peng Y, Ni X. Safety and efficacy of microwave ablation for symptomatic benign thyroid nodules in children. Eur Radiol 2024; 34:3851-3860. [PMID: 37938388 DOI: 10.1007/s00330-023-10282-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of microwave ablation (MWA) for the treatment of symptomatic benign thyroid nodules in children. METHODS A retrospective study of MWA for the treatment of 34 symptomatic benign thyroid nodules in 25 children was conducted. Volume reduction ratio (VRR), technique efficacy, symptom score, cosmetic score, and thyroid function were used to evaluate the efficacy of the technique. The associated complications and side effects were recorded. RESULTS The participants were followed for at least 6 months (median 12 months, range 6-48 months). After MWA treatment, the volumes of the targeted nodules decreased gradually (median volume 5.86 mL before MWA and 0.34 mL at the final follow-up assessment), the VRR achieved was up to 85.03% at the final follow-up assessment, and the technical efficacy at this time was 91.2%. The subjective and objective nodule-related symptoms were also ameliorated. The circulating hormone concentrations reflecting thyroid function remained within their normal ranges in all the participants after one month of follow-up. The procedure had no major complications. CONCLUSIONS MWA seems to be an effective and safe technique for the treatment of symptomatic benign thyroid nodules in pediatric patients. CLINICAL RELEVANCE STATEMENT Microwave ablation is a safe and effective method to treat symptomatic benign thyroid nodules in pediatric patients. This treatment may be selected if the patient or parents are not suitable or refuse to undergo surgery. KEY POINTS • Microwave ablation is effective in reducing the volume of benign thyroid nodules and ameliorating nodule-related symptoms in pediatric patients. • Microwave ablation is a safe method in children, with low complications. • Microwave ablation does not affect the circulating thyroid hormone concentrations of children.
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Affiliation(s)
- Wenyuan Shi
- Department of Ultrasound, National Center for Children's Health (Beijing), Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Wenjia Cai
- Department of Ultrasound, National Center for Children's Health (Beijing), Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Shengcai Wang
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health (Beijing), Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Yuanjin Gao
- Department of Ultrasound, National Center for Children's Health (Beijing), Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Rui Yang
- Department of Ultrasound, National Center for Children's Health (Beijing), Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Qinglin Liu
- Department of Ultrasound, National Center for Children's Health (Beijing), Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Yuanhu Liu
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health (Beijing), Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Yun Peng
- Department of Radiology, National Center for Children's Health (Beijing), Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Xin Ni
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health (Beijing), Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China.
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Metwalley KA, Farghaly HS. Subclinical hypothyroidism in children: updates for pediatricians. Ann Pediatr Endocrinol Metab 2021; 26:80-85. [PMID: 34218629 PMCID: PMC8255859 DOI: 10.6065/apem.2040242.121] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/12/2021] [Indexed: 01/02/2023] Open
Abstract
Subclinical hypothyroidism (SH) is defined as serum thyroid-stimulating hormone (TSH) above the upper limit of the reference range in the presence of normal free T4 concentrations. Depending on the degree of TSH elevation, SH could be defined as mild (TSH, 4.5-10 mIU/L) or severe (TSH>10 mIU/L). While there is a general consensus to treat children with serum TSH levels above 10 mU/L, the management of the mild form is uncertain and should be individualized. In this mini-review, we present a brief review of SH in children based on extensive literature review and long-standing clinical experience. This review provides the prevalence, causes, clinical presentation, consequences, investigation, and up-to-date therapeutic approach of SH in children. Generally, the purpose of the review is to provide pediatricians with an update of this common and continuously evolving condition.
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Affiliation(s)
- Kotb Abbass Metwalley
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt,Address for correspondence: Kotb Abbass Metwalley Pediatric Endocrinology Unit, Department of Pediatrics, Faculty of Medicine, Assiut University, 71111 Assiut, Egypt
| | - Hekma Saad Farghaly
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
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Pediatric differentiated thyroid carcinoma: An update from the APSA Cancer Committee. J Pediatr Surg 2020; 55:2273-2283. [PMID: 32553450 DOI: 10.1016/j.jpedsurg.2020.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/04/2020] [Accepted: 05/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Differentiated thyroid carcinomas (DTCs) are rare in young children but represent almost 10% of all malignancies diagnosed in older adolescents. METHODS This article reviews the recent literature describing surgical therapeutic approaches to pediatric DTC, associated complications, and long-term recurrence and survival outcomes. RESULTS Similar to adult thyroid cancers, pediatric DTCs are more common in females and are associated with thyroid nodules, family history of thyroid cancer, radiation exposure, iodine deficiency, autoimmune thyroid disease, and genetic syndromes. Management of thyroid cancers in children involves ultrasound imaging, fine needle aspiration, and surgical resection with treatment decisions based on clinical and radiological features, cytology and risk assessment. CONCLUSIONS Total thyroidectomy and compartment based resection of clinically involved lymph node basins form the cornerstone of treatment of DTC. There is an evolving literature regarding the use of molecular genetics to inform treatment strategies and the use of targeted therapies to treat iodine refractory and surgically unresectable progressive disease. TYPE OF STUDY Summary review. LEVEL OF EVIDENCE This is a review article of previously published Level 1-5 articles that includes expert opinion (Level 5).
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Wang J, Yu F, Shang Y, Ping Z, Liu L. Thyroid cancer: incidence and mortality trends in China, 2005-2015. Endocrine 2020; 68:163-173. [PMID: 32002755 DOI: 10.1007/s12020-020-02207-6] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/16/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Understanding secular trends of thyroid cancer is critical to plan strategies for cancer prevention and control. Our aim was to estimate the incidence and mortality trends of thyroid cancer in China during 2005-2015. METHODS A retrospective cohort evaluation of thyroid cancer cases and deaths during 2005-2015 was performed using population-based data from the Chinese Cancer Registry Annual Report. The incidence and mortality rates of thyroid cancer were stratified by gender, age group (0, 1-4, 5-9, 10-14…80-84, 85-), and area (urban or rural). A Joinpoint regression model was used to examine secular trends. RESULTS In China, the age-standardized incidence was 3.21/105 in 2005, and increased to 9.61/105 in 2015. Besides, a significant increase incidence rate was observed with the average annual percent change (AAPC) of 12.4% (95% CI: 10.5%-14.4%) in the period 2005-2015. The age-standardized mortality was 0.30/105 in 2005 and 0.35/105 in 2015, and the AAPC was 2.9% (95% CI: 1.3%-4.5%). For both incidence and mortality, the rates of thyroid cancer were much higher in females than in males, and in urban areas rather than rural areas; however, the rates of increasing trends showed no significant differences. With respect to the highest age-specific rates, it appeared in the age group of 50-54 years old for incidence and in the age group of 80-84 years old for mortality. Notably, the rate of increasing incidence trend was lower in older age groups, especially for people aged 70-79 years old. CONCLUSION A rapid increase in incidence and a moderate increase in mortality of thyroid cancer were observed from 2005 to 2015 in our study. Effective measures and tailored programs should be taken to curb the growth trend and reduce the disease burden.
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Affiliation(s)
- Junyi Wang
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Fangfang Yu
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Yanna Shang
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhiguang Ping
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
| | - Li Liu
- School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China.
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Imaging and Imaging-Based Management of Pediatric Thyroid Nodules. J Clin Med 2020; 9:jcm9020384. [PMID: 32024056 PMCID: PMC7074552 DOI: 10.3390/jcm9020384] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 12/11/2022] Open
Abstract
Thyroid nodules are less frequent in children than adults. Childhood thyroid nodules carry specific features, including a higher risk of malignancy than nodules in adults, rendering them unique in terms of management. Subsequently, they should be considered a distinct clinical entity with specific imaging recommendations. Initial evaluation requires a thorough workup, including clinical examination, and a detailed personal and familial history to determine the presence of possible risk factors. Laboratory and radiologic evaluation play an integral part in the diagnostic algorithm, with ultrasonography (US) being the first diagnostic test in all patients. US elastography has been recently introduced as an incremental method, reducing the subjectivity of the clinical diagnosis of nodule firmness associated with increased malignancy risk. However, fine-needle aspiration biopsy (FNAB) remains the mainstay in the diagnostic work-up of thyroid nodules and is documented to be best method for differentiating benign from malignant thyroid nodules. In addition, thyroid scintigraphy provides functional imaging information, which has a role both in the diagnostic management of thyroid nodules and during follow up in malignancies. Finally, despite providing additional information in certain clinical scenarios, 18F-fludeoxyglucose Positron Emission Tomography (18F-FDG-PET), computed tomography (CT), and magnetic resonance imaging (MRI) imaging are not routinely recommended for the evaluation of patients with newly detected thyroid nodules or in all cases of thyroid cancer. The objective of this review is to summarize the concepts in imaging and imaging-based management of nodular thyroid disease in the pediatric population, acknowledging the unique features that this patient group carries and the specific approach it requires.
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Kardelen Al AD, Yılmaz C, Poyrazoglu S, Tunca F, Bayramoglu Z, Bas F, Bundak R, Gilse Senyurek Y, Ozluk Y, Yegen G, Yeşil S, Darendeliler F. THE ROLE OF THYROID FINE-NEEDLE ASPIRATION CYTOLOGY IN THE TREATMENT AND FOLLOW-UP OF THYROID NODULES IN THE PEDIATRIC POPULATION. ACTA ENDOCRINOLOGICA-BUCHAREST 2019; 15:333-341. [PMID: 32010352 DOI: 10.4183/aeb.2019.333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective Thyroid fine-needle aspiration (FNA) and cytology is a reliable diagnostic method used in the assessment of malignancy when evaluating thyroid nodules, in conjunction with clinical and ultrasonographic findings. The aim of this study is to compare clinical, ultrasonographic, cytological and histopathological findings in children who underwent thyroid FNA. Methods Subjects comprised 80 patients (52 female) aged 13.7±2.8 years at the time of FNA who where evaluated for thyroid nodules. Clinical, ultrasonographic and cytological findings of patients were evaluated retrospectively. Results Autoimmune thyroiditis was present in 30% and history of radiotherapy to the head or neck in 10%. The cytological diagnosis of patients included: inadequate or hemorrhagic sample in 10%; benign in 42.5%; atypia or follicular lesion of undetermined significance (AUS/FLUS) in 15%; suspicion of follicular neoplasia (SFN) in 7.5%; suspicion of malignancy (SM) in 8.8%; and malignant in 16.3%. Thirty-seven patients underwent thyroidectomy. Malignancy rates for histopathologic follow-up were 75%, 85.7% and 100% for SFN, SM and malignant categories, respectively. Only one benign and two AUS/FLUS FNAs were found to be malignant on histopathological examination. Among patients who had received radioiodinetherapy, 87.5% had malignancy. In this study, the sensitivity of FNA was 96%, specificity 50%, positive predictive value 90.9%, negative predictive value 75%, and diagnostic value of FNA was 89.2%. Conclusion Thyroid FNA results were highly compatible with histopathological examination. Sensitivity, positive predictive value and diagnostic value of FNA were high.
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Affiliation(s)
- A D Kardelen Al
- Istanbul University - Pediatric Endocrinology, Istanbul, Turkey
| | - C Yılmaz
- Istanbul University - Pediatrics, Istanbul, Turkey
| | - S Poyrazoglu
- Istanbul University - Pediatric Endocrinology, Istanbul, Turkey
| | - F Tunca
- Istanbul University - General Surgery, Istanbul, Turkey
| | - Z Bayramoglu
- Istanbul University - Radiology, Istanbul, Turkey
| | - F Bas
- Istanbul University - Pediatric Endocrinology, Istanbul, Turkey
| | - R Bundak
- Istanbul University - Pediatric Endocrinology, Istanbul, Turkey
| | | | - Y Ozluk
- Istanbul University - Pathology, Fatih, Istanbul, Turkey
| | - G Yegen
- Istanbul University - Pathology, Fatih, Istanbul, Turkey
| | - S Yeşil
- Istanbul University - Pathology, Fatih, Istanbul, Turkey
| | - F Darendeliler
- Istanbul University - Pediatric Endocrinology, Istanbul, Turkey
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Kay-Rivest E, Mascarella MA, Puligandla P, Emil S, Saint-Martin C, Nguyen LHP, Daniel SJ, Baird R. Intrathyroidal thymic tissue in children: Avoiding unnecessary surgery. J Pediatr Surg 2018. [PMID: 29519570 DOI: 10.1016/j.jpedsurg.2018.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE Intrathyroidal thymic tissue may be misinterpreted as a thyroid lesion in children, leading to invasive tests or resection. We sought to describe the characteristic imaging features of these lesions and to evaluate the safety of non-operative management. METHODS A retrospective review of all patients less than 18years old with intrathyroidal thymic tissue from 2000 to 2016 was performed. Data collection included patient demographics, imaging results, interventions, and outcomes. RESULTS Eleven patients were identified using institutional radiology and pathology databases. Median patient age and lesion size at presentation were 5years old (range 2 to 8years old) and 0.9cm (range 0.4 to 9.2cm), respectively. Six lesions were incidentally identified, six were left-sided, and the most common location was the lower pole. Ultrasonographic features were reproducible and included well demarcated (10/11), hypoechoic lesions (11/11), containing punctate/linear internal echoes (11/11), and occasional mild hypervascularity (6/11). All cases demonstrated interval size and echotexture stability over a median surveillance period of 3years (range 1 to 8years). While 9 patients were simply observed, the first patient in this series underwent excision, while another had a fine needle aspiration to confirm pathology. LEVEL OF EVIDENCE Study of diagnostic test, Level IV. CONCLUSION Intrathyroidal thymic tissue has typical clinical and sonographic characteristics which allow for appropriate diagnosis and avoids thyroid resection.
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Affiliation(s)
- Emily Kay-Rivest
- Division of Otolaryngology - Head and Neck Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marco A Mascarella
- Division of Otolaryngology - Head and Neck Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Pramod Puligandla
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sherif Emil
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Christine Saint-Martin
- Division of Pediatric Radiology, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Lily H P Nguyen
- Division of Otolaryngology - Head and Neck Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sam J Daniel
- Division of Otolaryngology - Head and Neck Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Robert Baird
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
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Schultz KAP, Rednam SP, Kamihara J, Doros L, Achatz MI, Wasserman JD, Diller LR, Brugières L, Druker H, Schneider KA, McGee RB, Foulkes WD. PTEN, DICER1, FH, and Their Associated Tumor Susceptibility Syndromes: Clinical Features, Genetics, and Surveillance Recommendations in Childhood. Clin Cancer Res 2018; 23:e76-e82. [PMID: 28620008 DOI: 10.1158/1078-0432.ccr-17-0629] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/24/2017] [Accepted: 04/27/2017] [Indexed: 11/16/2022]
Abstract
PTEN hamartoma tumor syndrome (PHTS), DICER1 syndrome, and hereditary leiomyomatosis and renal cell cancer (HLRCC) syndrome are pleiotropic tumor predisposition syndromes that include benign and malignant neoplasms affecting adults and children. PHTS includes several disorders with shared and distinct clinical features. These are associated with elevated lifetime risk of breast, thyroid, endometrial, colorectal, and renal cancers as well as melanoma. Thyroid cancer represents the predominant cancer risk under age 20 years. DICER1 syndrome includes risk for pleuropulmonary blastoma, cystic nephroma, ovarian sex cord-stromal tumors, and multinodular goiter and thyroid carcinoma as well as brain tumors including pineoblastoma and pituitary blastoma. Individuals with HLRCC may develop multiple cutaneous and uterine leiomyomas, and they have an elevated risk of renal cell carcinoma. For each of these syndromes, a summary of the key syndromic features is provided, the underlying genetic events are discussed, and specific screening is recommended. Clin Cancer Res; 23(12); e76-e82. ©2017 AACRSee all articles in the online-only CCR Pediatric Oncology Series.
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Affiliation(s)
- Kris Ann P Schultz
- International Pleuropulmonary Blastoma Registry, Cancer and Blood Disorders, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - Surya P Rednam
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas
| | - Junne Kamihara
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Leslie Doros
- Cancer Genetics Clinic, Children's National Medical Center, Washington, DC
| | | | - Jonathan D Wasserman
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lisa R Diller
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Laurence Brugières
- Child and Adolescent Cancer Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Harriet Druker
- Division of Hematology/Oncology and Department of Genetic Counselling, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Katherine A Schneider
- Pediatric Cancer Genetic Risk Program, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rose B McGee
- Department of Oncology, Division of Cancer Predisposition, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - William D Foulkes
- Department of Human Genetics and Research Institute, McGill University Health Centre, McGill University, Montreal, Québec, Canada.
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Kalladi Puthanpurayil S, Francis GL, Kraft AO, Prasad U, Petersson RS. Papillary thyroid carcinoma presenting as acute suppurative thyroiditis: A case report and review of the literature. Int J Pediatr Otorhinolaryngol 2018; 105:12-15. [PMID: 29447798 DOI: 10.1016/j.ijporl.2017.11.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022]
Abstract
Acute suppurative thyroiditis is a rare, potentially life-threatening condition. We report the case of a 17-year-old male who initially presented with a thyroid abscess. Due to persistent symptoms and lack of evidence for underlying predisposing factors, he was followed closely and subsequently diagnosed with papillary thyroid cancer. He was successfully managed with surgery. His clinical course, radiological evaluation, and pathology reports are presented here along with a review of the literature. This case of papillary thyroid cancer highlights the need for close follow-up of patients presenting with a thyroid abscess, when other predisposing risk factors are not evident.
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Affiliation(s)
- Shabana Kalladi Puthanpurayil
- Division of Endocrinology, Department of Pediatrics, Children's Hospital of Richmond, Virginia Commonwealth University Health System, 1000 E Broad St, Richmond, VA 23219, United States.
| | - Gary L Francis
- Division of Endocrinology, Department of Pediatrics, Children's Hospital of Richmond, Virginia Commonwealth University Health System, 1000 E Broad St, Richmond, VA 23219, United States
| | - Adele O Kraft
- Department of Pathology, Virginia Commonwealth University Health System, 1200 E Marshall St, Richmond, VA 23298, United States.
| | - Uma Prasad
- Department of Radiology, Virginia Commonwealth University Health System, 1200 E Marshall St, Richmond, VA 23298, United States.
| | - Rajanya S Petersson
- Department of Otolaryngology - Head and Neck Surgery, Children's Hospital of Richmond, Virginia Commonwealth University Health System, 1200 E Broad St, West Hospital, 12th Floor, South Wing, Suite 313, PO Box 980146, Richmond, VA 23298, United States.
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Divarcı E, Çeltik Ü, Dökümcü Z, Ergün O, Özok G, Özen S, Şimşek DG, Darcan Ş, Çetingül N, Oral A, Ertan Y, Demirağ B, Çelik A. Management of Childhood Thyroid Nodules: Surgical and Endocrinological Findings in a Large Group of Cases. J Clin Res Pediatr Endocrinol 2017; 9:222-228. [PMID: 28387647 PMCID: PMC5596803 DOI: 10.4274/jcrpe.4272] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The management of childhood thyroid nodules is still a big challenge for clinicians. In this study, we aimed to present our surgical and endocrinological experience in more than one hundred pediatric cases. METHODS A retrospective analysis of patients admitted with a thyroid nodule between 2006 and 2014 was performed. Detailed ultrasonography and fine-needle aspiration biopsy (FNAB) were the cornerstones of the diagnostic approach. RESULTS One hundred-three children (72 female, 31 male) with a mean age of 13.1±3.6 years (3-18 years) were admitted to our center. Management strategy was surgery in 58 patients and follow-up in 45 patients. Mean nodule size was 17±12.7 mm (2-45 mm). The diagnoses were listed as benign solitary nodule (48 patients), thyroid carcinoma (26 patients), multinodular goiter (23 patients), Hashimoto thyroiditis (4 patients), and Graves' disease (2 patients). Surgical procedures were nodulectomy/lobectomy (32 patients), total thyroidectomy (TT) (13 patients), or TT+ neck dissection (13 patients). The rate of malignancy was 25% in the total group and 44% in the surgery group. The malignancy rate was higher in patients younger than 12 years compared to older children (41% vs. 17%, p=0.040). Metastasis was seen in 38% of the malignant nodules. Postoperative complications were transient hypocalcemia (8%), permanent hypocalcemia (1.7%), and unilateral vocal cord paralysis (1.7%). Recurrence or mortality was not encountered in the 5.4±1.2-year follow-up period. CONCLUSION Thyroid nodule in a child requires an aggressive diagnostic approach due to increased risk of malignancy and metastasis. Intraoperative frozen section examination must be done as a useful adjunct to determine the surgical strategy. Incidence of complications is small in thyroid surgery when performed by experienced surgeons.
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Affiliation(s)
- Emre Divarcı
- Ege University Faculty of Medicine, Department of Pediatric Surgery, İzmir, Turkey
,* Address for Correspondence: Ege University Faculty of Medicine, Department of Pediatric Surgery, İzmir, Turkey GSM: +90 535 726 87 63 E-mail:
| | - Ülgen Çeltik
- Ege University Faculty of Medicine, Department of Pediatric Surgery, İzmir, Turkey
| | - Zafer Dökümcü
- Ege University Faculty of Medicine, Department of Pediatric Surgery, İzmir, Turkey
| | - Orkan Ergün
- Ege University Faculty of Medicine, Department of Pediatric Surgery, İzmir, Turkey
| | - Geylani Özok
- Ege University Faculty of Medicine, Department of Pediatric Surgery, İzmir, Turkey
| | - Samim Özen
- Ege University Faculty of Medicine, Division of Pediatric Endocrinology, İzmir, Turkey
| | - Damla Gökşen Şimşek
- Ege University Faculty of Medicine, Division of Pediatric Endocrinology, İzmir, Turkey
| | - Şükran Darcan
- Ege University Faculty of Medicine, Division of Pediatric Endocrinology, İzmir, Turkey
| | - Nazan Çetingül
- Ege University Faculty of Medicine, Division of Pediatric Oncology, İzmir, Turkey
| | - Aylin Oral
- Ege University Faculty of Medicine, Department of Nuclear Medicine, İzmir, Turkey
| | - Yeşim Ertan
- Ege University Faculty of Medicine, Department of Pathology, İzmir, Turkey
| | - Bengü Demirağ
- Dr. Behçet Uz Children’s Hospital, Division of Pediatric Oncology, İzmir, Turkey
| | - Ahmet Çelik
- Ege University Faculty of Medicine, Department of Pediatric Surgery, İzmir, Turkey
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Ly S, Frates MC, Benson CB, Peters HE, Grant FD, Drubach LA, Voss SD, Feldman HA, Smith JR, Barletta J, Hollowell M, Cibas ES, Moore FD, Modi B, Shamberger RC, Huang SA. Features and Outcome of Autonomous Thyroid Nodules in Children: 31 Consecutive Patients Seen at a Single Center. J Clin Endocrinol Metab 2016; 101:3856-3862. [PMID: 27501280 PMCID: PMC5052348 DOI: 10.1210/jc.2016-1779] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
CONTEXT Most thyroid nodules are benign and their accurate identification can avoid unnecessary procedures. In adult patients, documentation of nodule autonomy is accepted as reassurance of benign histology and as justification to forgo biopsy or thyroidectomy. In contrast, the negative predictive value of nodule autonomy in children is uncertain. Some recent publications recommend surgical resection as initial management, but few address the degree of TSH suppression or the specific scintigraphic criteria used to diagnose autonomy. OBJECTIVE The objective of the study was to study the presenting features and cancer risk of children with autonomous nodules. DESIGN AND SETTING Medical records of all 31 children diagnosed with autonomous nodules at our center from 2003 to 2014 were retrospectively reviewed. PATIENTS AND RESULTS All children met full diagnostic criteria for autonomous nodules, defined by both autonomous 123I uptake into the nodule and the suppression of uptake in the normal thyroid parenchyma on scintigraphy performed during hypothyrotropinemia. The median age of presentation was 15 years (range 3-18 y) with a female to male ratio of 15:1. Fifty-eight percent of patients had solitary nodules and 42% had multiple nodules. The median size of each patient's largest autonomous nodule was 39 mm (range 18-67 mm). Most of the children in this series (68%) had diagnostic biopsies and/or operative pathology of their largest autonomous nodule, which showed benign cytology or histology in all cases. CONCLUSIONS In this pediatric series, the cancer rate observed in biopsied or resected autonomous nodules was 0%. Whereas larger studies are needed to confirm our findings, these results agree with earlier reports suggesting that thyroid cancer is rare in rigorously defined autonomous nodules and support that conservative management may be offered to selected children who meet strict diagnostic criteria for autonomous nodules, deferring definitive therapies until adulthood when the risks of thyroidectomy and 131I ablation are lower.
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Affiliation(s)
- Samantha Ly
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Mary C Frates
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Carol B Benson
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Hope E Peters
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Frederick D Grant
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Laura A Drubach
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Stephan D Voss
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Henry A Feldman
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Jessica R Smith
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Justine Barletta
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Monica Hollowell
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Edmund S Cibas
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Francis D Moore
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Biren Modi
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Robert C Shamberger
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
| | - Stephen A Huang
- Thyroid Program of the Division of Endocrinology (S.L., F.D.G., H.A.F., J.R.S., S.A.H.), Clinical Research Center (H.A.F.), and Departments of Radiology (F.D.G., L.A.D., S.D.V., S.A.H.), Pathology (M.H., E.S.C.), and Surgery (B.M., R.C.S.), Boston Children's Hospital, and Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (S.A.H.), and Departments of Radiology (M.C.F., C.B.B., H.E.P.), Pathology (J.B., E.S.C.), and Surgery (F.D.M.), Brigham and Women's Hospital, and the Dana Farber Cancer Institute (S.A.H.), Boston, Massachusetts 02115
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