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Gallant JN, Weiss VL, Chen SC, Liang J, Belcher RH, Ye F, Correa H, Wang H. Hashimoto's Thyroiditis and the Risk of Papillary Thyroid Cancer in Children. Cancers (Basel) 2023; 15:4902. [PMID: 37835596 PMCID: PMC10572053 DOI: 10.3390/cancers15194902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/09/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023] Open
Abstract
The association between Hashimoto's thyroiditis (HT) and pediatric thyroid cancer is controversial. Most studies examining this connection have been based on adults, and larger studies in children are lacking. We performed a retrospective study of all sequential pediatric patients who underwent a thyroidectomy for a neoplasm at our institution over a twenty-year period in order to explore the link between HT and pediatric thyroid cancer. A total of 153 patients, median age 16.5 (interquartile range [IQR] 14.2-18.3) years, underwent thyroid surgery for a neoplasm. Patients were mainly female (80%) and White (84%). Median follow-up was 58.6 (IQR 20.7-105.4) months. Thirty-five (23%) patients had HT. Patients who underwent thyroid surgery and had HT were more likely to harbor a malignant neoplasm (p = 0.05); specifically, papillary thyroid carcinoma (PTC, p = 0.02). There was a difference in the distribution of HT among the subtypes of PTC (p = 0.03). Despite this, there was no difference in terms of survival between patients with/without HT. In conclusion, children with a thyroid malignancy, specifically, PTC, are more likely to have HT. The association between HT and pediatric PTC appears to be subtype-specific but does not seem to affect patient survival.
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Affiliation(s)
- Jean-Nicolas Gallant
- Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Vivian L. Weiss
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Sheau-Chiann Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Jiancong Liang
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Monroe Carell Jr. Children’s Hospital, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Ryan H. Belcher
- Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Monroe Carell Jr. Children’s Hospital, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Fei Ye
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Hernan Correa
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Monroe Carell Jr. Children’s Hospital, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Huiying Wang
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Monroe Carell Jr. Children’s Hospital, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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Januś D, Wójcik M, Taczanowska-Niemczuk A, Kiszka-Wiłkojć A, Kujdowicz M, Czogała M, Górecki W, Starzyk JB. Ultrasound, laboratory and histopathological insights in diagnosing papillary thyroid carcinoma in a paediatric population: a single centre follow-up study between 2000-2022. Front Endocrinol (Lausanne) 2023; 14:1170971. [PMID: 37274328 PMCID: PMC10233204 DOI: 10.3389/fendo.2023.1170971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/03/2023] [Indexed: 06/06/2023] Open
Abstract
Background Papillary thyroid carcinoma (PTC) often coincides with autoimmune thyroiditis (AIT); whether this association is incidental or causal remains debated. Objective To evaluate the ultrasonographic, laboratory, and histopathological features of PTC in paediatric patients with and without AIT and its relationship to puberty. Design A retrospective cohort study. Patients and methods A retrospective analysis of medical records of 90 patients (69; 76.7% females). The mean age at PTC diagnosis was 13.8 years [range 6-18]. All patients were evaluated ultrasonographically before thyroid surgery. Thyroid nodules were categorised using the European Thyroid Imaging Reporting and Data System (EU-TIRADS PL), and cytopathology was assessed using Bethesda criteria. Neck ultrasound results and thyroid and autoimmune status were correlated with histopathological PTC assessment. Results The coexistence of PTC and AIT was found in 48.9% (44/90) of patients. The percentage of AIT was increasing with age; AIT was present only in 1/3 of prepubertal, close to 50% in pubertal, and over 60% in adolescent patients. The youngest patients (aged <10 years old) presented more often with goitre and lymphadenopathy and less often with AIT than adolescents (15-18 years of age). There were no differences in TPOAb, TgAb, and TSH levels between the age subgroups. Presurgical TgAb levels were higher than those of TPOAb in the youngest patients. Histopathological analysis revealed that the solid subtype was observed more often in prepubertal children and diffuse sclerosing in children below 14 years of age, whereas the classic subtype dominated in late pubertal. Univariate and multivariate analyses revealed that lymph nodes metastases (LNM) were associated with PTC diameter and fT4 level, whereas extrathyroidal extension with age and angioinvasion with PTC diameter and age. The correlations between age and fibrosis, and the presence of psammoma bodies in malignant tissues were close to significant. We did not observe an association between TSH levels and the presence of autoimmunity and PTC variables. Conclusions In paediatric patients the natural course of PTC may be less aggressive in adolescent patients than in younger children (especially < 10 years of age). We suggest that pre-operative evaluation of paediatric patients with thyroid nodules could include apart from assessment of thyroid hormones, evaluation of TPOAb, TgAb, and TRAb together with comprehensive neck ultrasonography.
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Affiliation(s)
- Dominika Januś
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University, Medical College, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children’s Hospital, Krakow, Poland
| | - Małgorzata Wójcik
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University, Medical College, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children’s Hospital, Krakow, Poland
| | - Anna Taczanowska-Niemczuk
- Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University, Medical College, Krakow, Poland
- Department of Pediatric Surgery, University Children’s Hospital, Krakow, Poland
| | - Aleksandra Kiszka-Wiłkojć
- Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University, Medical College, Krakow, Poland
- Department of Pediatric Surgery, University Children’s Hospital, Krakow, Poland
| | - Monika Kujdowicz
- Department of Pathology, University Children’s Hospital, Krakow, Poland
- Department of Pathomorphology, Jagiellonian University, Medical College, Krakow, Poland
| | - Małgorzata Czogała
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University, Medical College, Krakow, Poland
- Department of Pediatric Oncology and Hematology, University Children’s Hospital, Krakow, Poland
| | - Wojciech Górecki
- Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University, Medical College, Krakow, Poland
- Department of Pediatric Surgery, University Children’s Hospital, Krakow, Poland
| | - Jerzy B. Starzyk
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University, Medical College, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children’s Hospital, Krakow, Poland
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Januś D, Kujdowicz M, Wójcik M, Taczanowska-Niemczuk A, Kiszka-Wiłkojć A, Górecki W, Starzyk JB. Ultrasound evolution of parenchymal changes in the thyroid gland with autoimmune thyroiditis in children prior to the development of papillary thyroid carcinoma - a follow-up study. Front Endocrinol (Lausanne) 2023; 14:1172823. [PMID: 37124746 PMCID: PMC10130420 DOI: 10.3389/fendo.2023.1172823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/29/2023] [Indexed: 05/02/2023] Open
Abstract
Background Follicular cell-derived thyroid carcinoma represents the vast majority of paediatric thyroid cancers (TCs). Papillary thyroid carcinoma (PTC) accounts for over 90% of all childhood TC cases, and its incidence in paediatric patients is increasing. The objective of this follow-up study was to present the outcome of ultrasound (US) and laboratory monitoring of paediatric patients with autoimmune thyroiditis (AIT) prior to the development of PTC. Patients and methods This prospective study included 180 children and adolescents (132 females; 73.3%) with a suspicion of thyroid disorder referred to the Outpatient Endocrine Department. The patients were divided into four groups: 1) 28 patients with a mean age of 10.7 [standard deviation (SD), 3.1] y, in whom PTC was detected during the active surveillance of AIT [AIT(+), PTC(+) follow up (F)]; 2) 18 patients with a mean age of 12.8 (SD, 3.4) y, in whom PTC and AIT were detected upon admission (A) [AIT(+), PTC(+) A]; 3) 45 patients with a mean age of 13.0 (SD, 3.4) y, in whom PTC was detected upon admission and AIT was excluded [AIT(-), PTC(+) A]; and 4) an age- and sex-matched control group of 89 patients with AIT and with a mean age of 9.4 (SD, 3.0) y. The analysis included clinical, US, and laboratory assessment results of children on admission (groups 1-4) and during follow-up (groups 1 and 4) in the Paediatric Endocrine Outpatient Department. Results Upon admission of those in group 1, the US evaluation revealed a hypoechogenic thyroid gland in 12 and an irregular normoechogenic gland in 16 patients. US monitoring revealed an increase in thyroid echogenicity and an increased irregularity of the thyroid structure during the follow-up period of all of the patients from group 1. Such changes were not noticed in group 4. PTC was diagnosed at the mean time of 3.6 y (3 mo-9 y) since AIT confirmation in group 1. The mean maximum PTC diameter as per the US was significantly smaller in group 1 than in groups 2 and 3 [13.2 (10.8) mm vs. 22.2 (12.8) and 22.05 (15.4) mm]. Fewer patients in group 1 were referred to 131I than in groups 2 and 3 (71.4% vs. 94.4 and 93.3%). Interestingly, significant differences were observed in the thyroglobulin antibody (TgAb)/thyroid peroxidase antibody (TPOAb) ratio between groups 2 and 3, as opposed to group 4, at the beginning of observation [15.3 (27.6) and 3.5 (8.8] vs. 0.77 (1.9)]. In group 1, after the follow-up, an increase in the TgAb/TPOAb ratio was observed [1.2 (9.8) to 5.2 (13.5)]. There were no significant differences between groups 1-3 in labeling index Ki67, lymph nodes metastasis, extrathyroidal extension, and angioinvasion. There were no associations between thyroid-stimulating hormone, TgAb, and the extent of the disease. Conclusion The use of thyroid US focused on the search for developing tumours in the routine follow-up of patients with AIT may not only help in the early detection of thyroid malignancies that are not clinically apparent but may also influence the invasiveness of oncological therapy and reduce the future side effects of 131I therapy. We propose that the repeat evaluation of TPOAb and TgAb warrants further exploration as a strategy to determine TC susceptibility in paediatric patients with AIT in larger multicentre studies.
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Affiliation(s)
- Dominika Januś
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital in Krakow, Krakow, Poland
| | - Monika Kujdowicz
- Department of Pathomorphology, Jagiellonian University Medical College, Krakow, Poland
- Department of Pathology, University Children Hospital in Krakow, Krakow, Poland
| | - Małgorzata Wójcik
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital in Krakow, Krakow, Poland
| | - Anna Taczanowska-Niemczuk
- Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric Surgery, University Children Hospital in Krakow, Krakow, Poland
| | - Aleksandra Kiszka-Wiłkojć
- Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric Surgery, University Children Hospital in Krakow, Krakow, Poland
| | - Wojciech Górecki
- Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric Surgery, University Children Hospital in Krakow, Krakow, Poland
| | - Jerzy B. Starzyk
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital in Krakow, Krakow, Poland
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Elastographic Evaluation of Thyroid Nodules in Children and Adolescents with Hashimoto’s Thyroiditis and Nodular Goiter with Reference to Cytological and/or Histopathological Diagnosis. J Clin Med 2022; 11:jcm11216339. [DOI: 10.3390/jcm11216339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/10/2022] [Accepted: 10/22/2022] [Indexed: 11/16/2022] Open
Abstract
There are data indicating the coexistence of papillary thyroid carcinoma and autoimmune thyroiditis (AIT) in children. The aim of the study was elastographic evaluation of thyroid nodules in children and adolescents with AIT and nodular goiter in relation to cytological and/or histopathological diagnosis. We examined 215 children (57 boys and 158 girls) with 261 thyroid nodules (143 non-AIT and 118 AIT). All study participants underwent a conventional ultrasound examination with elastography followed by fine needle aspiration biopsy (FNAB). Abnormal Strain Ratio (SR ≥ 5) was observed in 36 non-AIT nodules and 15 AIT nodules. Papillary thyroid carcinoma was diagnosed in 5 patients (2% of all investigated nodules). SR of malignant thyroid nodules was statistically higher in comparison to SR of benign nodules both in the group of non-AIT (6 ± 4 vs. 3.67 ± 2.62, p = 0.024) and AIT nodules (6.3 ± 0.01 vs. 2.92 ± 1.89, p = 0.047). Comparison of non-AIT and AIT benign nodules revealed that SR was higher in non-AIT nodules (3.67 ± 2.62 vs. 2.92 ± 1.89, p = 0.01). We observed a strong positive correlation (R = 1) between TSH concentration and SR ratio in the group of all malignant thyroid nodules. Autoimmune inflammatory process of the thyroid gland does not limit the use of elastography in the diagnosis of thyroid nodules in children.
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Zhang X, Lee VCS, Rong J, Lee JC, Song J, Liu F. A multi-channel deep convolutional neural network for multi-classifying thyroid diseases. Comput Biol Med 2022; 148:105961. [PMID: 35985185 DOI: 10.1016/j.compbiomed.2022.105961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 07/28/2022] [Accepted: 08/06/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVE Thyroid disease instances have been continuously increasing since the 1990s, and thyroid cancer has become the most rapidly rising disease among all the malignancies in recent years. Most existing studies focused on applying deep convolutional neural networks for detecting thyroid cancer. Despite their satisfactory performance on binary classification tasks, limited studies have explored multi-class classification of thyroid disease types; much less is known of the diagnosis of co-existence situation for different types of thyroid diseases. METHOD This study proposed a novel multi-channel convolutional neural network (CNN) architecture to address the multi-class classification task of thyroid disease. The multi-channel CNN merits from computed tomography characteristics to drive a comprehensive diagnostic decision for the overall thyroid gland, emphasizing the disease co-existence circumstance. Moreover, this study also examined alternative strategies to enhance the diagnostic accuracy of CNN models through concatenation of different scales of feature maps. RESULTS Benchmarking experiments demonstrate the improved performance of the proposed multi-channel CNN architecture compared with the standard single-channel CNN architecture. More specifically, the multi-channel CNN achieved an accuracy of 0.909±0.048, precision of 0.944±0.062, recall of 0.896±0.047, specificity of 0.994±0.001, and F1 of 0.917±0.057, in contrast to the single-channel CNN, which obtained 0.902±0.004, 0.892±0.005, 0.909±0.002, 0.993±0.001, 0.898±0.003, respectively. In addition, the proposed model was evaluated in different gender groups; it reached a diagnostic accuracy of 0.908 for the female group and 0.901 for the male group. CONCLUSION Collectively, the results highlight that the proposed multi-channel CNN has excellent generalization and has the potential to be deployed to provide computational decision support in clinical settings.
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Affiliation(s)
- Xinyu Zhang
- Department of Data Science and AI, Faculty of IT, Monash University, Clayton, Melbourne, VIC 3800, Australia
| | - Vincent C S Lee
- Department of Data Science and AI, Faculty of IT, Monash University, Clayton, Melbourne, VIC 3800, Australia.
| | - Jia Rong
- Department of Data Science and AI, Faculty of IT, Monash University, Clayton, Melbourne, VIC 3800, Australia
| | - James C Lee
- Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, VIC 3004, Australia; Department of Surgery, Monash University, Melbourne, VIC 3168, Australia
| | - Jiangning Song
- Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Clayton, Melbourne, VIC 3800, Australia
| | - Feng Liu
- West China Hospital of Sichuan University, Chengdu City, Sichuan Province 332001, China
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Keefe G, Culbreath K, Cherella CE, Smith JR, Zendejas B, Shamberger RC, Richman DM, Hollowell ML, Modi BP, Wassner AJ. Autoimmune Thyroiditis and Risk of Malignancy in Children with Thyroid Nodules. Thyroid 2022; 32:1109-1117. [PMID: 35950619 DOI: 10.1089/thy.2022.0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: It is uncertain whether the presence of autoimmune thyroiditis (AIT) increases the risk of thyroid cancer in children with thyroid nodules. This study evaluated the association between AIT and thyroid cancer in pediatric patients with thyroid nodules. Methods: A cross-sectional study was performed of pediatric patients (<19 years old) with a thyroid nodule (≥1 cm) who underwent fine-needle aspiration in an academic pediatric thyroid center. AIT was defined by the presence of thyroid autoantibodies or diffusely heterogeneous sonographic echotexture. The primary outcome was diagnosis of thyroid cancer. The association of AIT with thyroid cancer was evaluated with univariable and multivariable logistic regression. Associations of AIT with subject and nodule characteristics were also assessed. Results: Four hundred fifty-eight thyroid nodules in 385 patients (81% female) were evaluated at a median age of 15.5 years (interquartile range 13.5-17.0). Thyroid cancer was present in 108 nodules (24%). AIT was present in 95 subjects (25%) and was independently associated with an increased risk of thyroid cancer (multivariable odds ratio [OR] 2.19, 95% confidence interval [CI] 1.32-3.62). Thyroid cancer was also independently associated with younger age, nodule size, and solitary nodules, but was not associated with serum thyrotropin concentration. AIT was not associated with the likelihood of subjects undergoing thyroid surgery (p = 0.17). AIT was less commonly associated with follicular thyroid carcinoma than with papillary thyroid carcinoma (OR 0.22, CI 0.05-1.06). Among papillary thyroid carcinomas, AIT was strongly associated with the diffuse sclerosing variant (OR 4.74, CI 1.33-16.9). AIT was not associated with the extent of local, regional, or distant disease at thyroid cancer diagnosis. Conclusions: AIT is independently associated with an increased risk of thyroid cancer in children with thyroid nodules. These findings suggest that the evaluation of thyroid autoantibodies and thyroid echotexture may inform thyroid cancer risk assessment and surgical decision-making in children with thyroid nodules.
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Affiliation(s)
| | | | - Christine E Cherella
- Thyroid Center, Boston, Massachusetts, USA
- Division of Endocrinology, Department of Pediatrics, Boston, Massachusetts, USA
| | - Jessica R Smith
- Thyroid Center, Boston, Massachusetts, USA
- Division of Endocrinology, Department of Pediatrics, Boston, Massachusetts, USA
| | - Benjamin Zendejas
- Department of Surgery, Boston, Massachusetts, USA
- Thyroid Center, Boston, Massachusetts, USA
| | - Robert C Shamberger
- Department of Surgery, Boston, Massachusetts, USA
- Thyroid Center, Boston, Massachusetts, USA
| | - Danielle M Richman
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Monica L Hollowell
- Thyroid Center, Boston, Massachusetts, USA
- Department of Pathology; Boston Children's Hospital, Boston, Massachusetts, USA
| | - Biren P Modi
- Department of Surgery, Boston, Massachusetts, USA
- Thyroid Center, Boston, Massachusetts, USA
| | - Ari J Wassner
- Thyroid Center, Boston, Massachusetts, USA
- Division of Endocrinology, Department of Pediatrics, Boston, Massachusetts, USA
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Abbasgholizadeh P, Naseri A, Nasiri E, Sadra V. Is Hashimoto thyroiditis associated with increasing risk of thyroid malignancies? A systematic review and meta-analysis. Thyroid Res 2021; 14:26. [PMID: 34861884 PMCID: PMC8641157 DOI: 10.1186/s13044-021-00117-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/16/2021] [Indexed: 11/21/2022] Open
Abstract
Background and purpose Hashimoto thyroiditis (HT) is the most common inflammatory autoimmune thyroid disease and also the most common cause of hypothyroidism in developed countries. There is evidence of the role of HT in developing thyroid cancers (TCs). This study investigated the association between HT and different types of TCs. Methods Results of a comprehensive search in three major databases, as well as hand searching, were screened in title/abstract and full-text stages and the relevant data were extracted from the studies that met the inclusion criteria. Risk of bias (RoB) was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools and the meta-analysis was conducted with Comprehensive Meta-Analysis software. Results Out of 4785 records, 50 studies were included in the systematic review, and 27 of them met the criteria for quantitative synthesis. The results indicated a significant role for HT in developing papillary TC (OR: 1.65; 95% CI: 1.04 to 2.61), medullary TC (OR: 2.70; 95% CI: 1.20 to 6.07) and lymphoma (OR:12.92; 95% CI: 2.15 to 77.63); but not anaplastic TC (OR: 1.92; 95% CI: 0.29 to 1.90) and follicular TC (OR: 0.73; 95% CI: 0.41 to 1.27). Also, this study found a significant association between HT and thyroid malignancies (OR: 1.36; 95% CI: 1.05 to 1.77). Conclusion Although we found a significant association between HT and some types of TCs, High RoB studies, high level of heterogeneity, and the limited number of well-designed prospective studies, suggested the need for more studies to reach more reliable evidence. Supplementary Information The online version contains supplementary material available at 10.1186/s13044-021-00117-x.
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Affiliation(s)
| | - Amirreza Naseri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.,Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ehsan Nasiri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.,Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahideh Sadra
- Endocrine Research Center, Tabriz University of Medical Sciences, Golgasht street, Tabriz, Iran.
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Lee YJ, Cho YJ, Heo YJ, Chung EJ, Choi YH, Kim JI, Park YJ, Shin CH, Lee YA. Thyroid nodules in childhood-onset Hashimoto's thyroiditis: Frequency, risk factors, follow-up course and genetic alterations of thyroid cancer. Clin Endocrinol (Oxf) 2021; 95:638-648. [PMID: 33894068 DOI: 10.1111/cen.14490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/28/2021] [Accepted: 04/07/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE We evaluated the frequency, risk factors and the follow-up outcomes of thyroid nodules, and genetic alterations in thyroid cancer, in youth with childhood-onset Hashimoto thyroiditis (HT) residing in an iodine-sufficient country. DESIGN A retrospective cohort study. PATIENTS AND MEASUREMENTS A total of 213 patients (194 females, mean age 10.6 years at the time of HT diagnosis) were ultrasonographically evaluated. Thyroid nodules were categorized using the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and the American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TI-RADS). RESULTS Thyroid nodules were detected in 40 (18.8%) patients over a median follow-up period of 3.4 years, usually after the onset of puberty. A family history of thyroid disease (hazard ratio 2.1, p = .031) was predictive of thyroid nodule detection. Papillary thyroid carcinoma (PTC) was diagnosed in 9 (4.2% of all and 22.5% of nodule-positive patients). The malignant nodules had a higher K-TIRADS or ACR-TI-RADS risk level compared with benign nodules (p < .01 for both). Genetic alterations were revealed in 7 (BRAFV600E in 6 and RET-ERC1 fusion in 1) of the eight available tumour tissue samples. None showed evidence of disease over a median follow-up period of 3.4 years. CONCLUSIONS The nodule detection rate was 18.8%, with a 22.5% risk of malignancy among the detected nodules in childhood-onset HT patients, showing increased risk in those with a family history. Additional large-scale studies are required to evaluate the usefulness of K-TIRADS or ACR-TI-RADS risk level for the differentiation of paediatric thyroid nodules.
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Affiliation(s)
- Yun Jeong Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea
| | - Yeon Jin Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - You Joung Heo
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jong-Il Kim
- Medical Research Center, Genomic Medicine Institute, Seoul National University, Seoul, Korea
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea
- Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Young Joo Park
- Medical Research Center, Genomic Medicine Institute, Seoul National University, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea
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Li S, Liu Y, Liu S, Du G, Wang Z, Yin D. Predictive Values of Inflammation-Related Markers and Thyroid Function in Pediatric Thyroid Cancer Patients. Front Pediatr 2021; 9:802214. [PMID: 35004550 PMCID: PMC8740167 DOI: 10.3389/fped.2021.802214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/29/2021] [Indexed: 12/18/2022] Open
Abstract
Few researchers have studied the diagnostic value of inflammation-related hematological indexes of pediatric thyroid carcinoma exclusively. Whether thyroid-stimulating hormone (TSH) is an independent risk factor for pediatric thyroid cancer is still controversial. To assess the correlativity and predictive values of inflammation-related markers and thyroid function in pediatric thyroid cancer patients, we collected a total of 270 children with thyroid nodules for two consecutive years. Clinical data including age, gender, thyroid function, inflammation indexes, and clinical pathologic finding were collected and analyzed. The above-mentioned data were compared between the benign group and the malignant group, followed by the subgroups comparison. Binary logistic regression analysis was used to evaluate the correlation of markers and the pathological features of thyroid nodules. The neutrophil-to-lymphocyte ratio (NLR) showed a significant difference between thyroid cancer and thyroid nodules, while TSH did not. NLR > 1.49529 was the prognostic indicator of pediatric thyroid cancer. The logistic regression model further revealed that NLR > 1.49529 was an independent risk factor for thyroid cancer in pediatric patients. Furthermore, TSH was not correlated with the tumor characteristics in the thyroid cancer group. In conclusion, the findings in this study showed that NLR could be a predictor of thyroid cancer in pediatric patients and refuted the present view that TSH is a risk factor in pediatric thyroid cancer.
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Affiliation(s)
- Shuo Li
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yihao Liu
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shaoxuan Liu
- Department of Anethesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Gongbo Du
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zipeng Wang
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Detao Yin
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, China
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10
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Sur ML, Gaga R, Lazăr C, Lazea C, Aldea C, Sur D. Papillary thyroid carcinoma in children with Hashimoto's thyroiditis - a review of the literature between 2000 and 2020. J Pediatr Endocrinol Metab 2020; 33:1511-1517. [PMID: 33180046 DOI: 10.1515/jpem-2020-0383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/22/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Thyroid cancer is the most common pediatric endocrine neoplasm representing 3% of all malignancies in children. Hashimoto's thyroiditis (HT) is also a common disorder in the pediatric age range. Patients with HT frequently develop enlarged thyroid with nodules. We aimed to provide a literature review on the frequency of papillary thyroid carcinoma (PTC) in patients with HT. CONTENT A literature search of the PubMed database between 2000 and 2020 was performed, using the relevant keywords "papillary thyroid carcinoma," "Hashimoto's thyroiditis" and "children". We followed the PRISMA statement guidelines during the preparation of this review. Six studies (n=2,065 patients with HT) were retained for the final analysis. The follow-up of the patients with HT was from 2 to 10 years. PTC was diagnosed in 0.67-7.87% of the HT patients included in these studies. In patients with HT and nodules, the percentage of PTC varied between 5.13 and 35%. The overall occurrence of PTC in patients with HT was 3.07%. SUMMARY AND OUTLOOK The number of patients developing thyroid nodules in relation to HT was increased. The development of PTC in children with HT appeared to be higher than in the normal population.
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Affiliation(s)
- Maria Lucia Sur
- Department of Pediatrics, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Remus Gaga
- Department of Pediatrics, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Călin Lazăr
- Department of Pediatrics, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Cecilia Lazea
- Department of Pediatrics, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Cornel Aldea
- Department of Pediatrics, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Daniel Sur
- Department of Medical Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,The Oncology Institute "Prof. Dr. Ion Chiricuta", Cluj-Napoca, Romania
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11
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Paulson VA, Rudzinski ER, Hawkins DS. Thyroid Cancer in the Pediatric Population. Genes (Basel) 2019; 10:genes10090723. [PMID: 31540418 PMCID: PMC6771006 DOI: 10.3390/genes10090723] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 12/26/2022] Open
Abstract
Thyroid cancer is rare in the pediatric population, but thyroid carcinomas occurring in children carry a unique set of clinical, pathologic, and molecular characteristics. In comparison to adults, children more often present with aggressive, advanced stage disease. This is at least in part due to the underlying biologic and molecular differences between pediatric and adult thyroid cancer. Specifically, papillary thyroid carcinoma (which accounts for approximately 90% of pediatric thyroid cancer) has a high rate of gene fusions which influence the histologic subtypes encountered in pediatric thyroid tumors, are associated with more extensive extrathyroidal disease, and offer unique options for targeted medical therapies. Differences are also seen in pediatric follicular thyroid cancer, although there are few studies of non-papillary pediatric thyroid tumors published in the literature due to their rarity, and in medullary carcinoma, which is most frequently diagnosed in the pediatric population in the setting of prophylactic thyroidectomies for known multiple endocrine neoplasia syndromes. The overall shift in the spectrum of histotypes and underlying molecular alterations common in pediatric thyroid cancer is important to recognize as it may directly influence diagnostic test selection and therapeutic recommendations.
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Affiliation(s)
- Vera A Paulson
- Dept. of Laboratory Medicine, University of Washington Medical Center, 1959 NE Pacific St, Box 357110, Seattle, WA 98105, USA.
| | - Erin R Rudzinski
- Dept. of Laboratories, Seattle Children's Hospital, OC.8.720; 4800 Sandpoint Way NE, Seattle, WA 98105, USA.
| | - Douglas S Hawkins
- University of Washington Medical Center, Fred Hutchinson Cancer Research Center and Cancer and Blood Disorders Center, Seattle Children's Hospital, MB.8.501, Seattle, WA 98105, USA.
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12
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Malagón C, Gomez MDP, Mosquera C, Vargas C, Gonzalez T, Arango C, Martin L, Perez P, Amaya-Uribe L, Molano-Gonzalez N, Anaya JM. Juvenile polyautoimmunity in a rheumatology setting. Autoimmun Rev 2019; 18:369-381. [DOI: 10.1016/j.autrev.2018.11.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 11/10/2018] [Indexed: 02/06/2023]
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13
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Hu Y, Li N, Jiang P, Cheng L, Ding B, Liu XM, He K, Zhu YQ, Liu BL, Cao X, Zhou H, Mao XM. Elevated thyroglobulin level is associated with dysfunction of regulatory T cells in patients with thyroid nodules. Endocr Connect 2019; 8:309-317. [PMID: 30822273 PMCID: PMC6432874 DOI: 10.1530/ec-18-0545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 03/01/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Thyroid nodules are usually accompanied by elevated thyroglobulin (Tg) level and autoimmune thyroid diseases (AITDs). However, the relationship between Tg and AITDs is not fully understood. Dysfunction of regulatory T cells (Tregs) plays an important role in the development of AITDs. We aimed to evaluate the effects of Tg on the function of Tregs in patients with thyroid nodules. METHODS Tg levels and the functions of Tregs in peripheral blood and thyroid tissues of patients with thyroid nodules from Nanjing First Hospital were evaluated. The effects of Tg on the function of Tregs from healthy donors were also assessed in vitro. The function of Tregs was defined as an inhibitory effect of Tregs on the effector T cell (CD4+ CD25- T cell) proliferation rate. RESULTS The level of Tg in peripheral blood correlated negatively with the inhibitory function of Tregs (R = 0.398, P = 0.03), and Tregs function declined significantly in the high Tg group (Tg >77 μg/L) compared with the normal Tg group (11.4 ± 3.9% vs 27.5 ± 3.5%, P < 0.05). Compared with peripheral blood, the function of Tregs in thyroid declined significantly (P < 0.01), but the proportion of FOXP3+ Tregs in thyroid increased (P < 0.01). High concentration of Tg (100 μg/mL) inhibited the function of Tregs and downregulated FOXP3, TGF-β and IL-10 mRNA expression in Tregs in vitro. CONCLUSIONS Elevated Tg level could impair the function of Tregs, which might increase the risk of AITDs in patient with thyroid nodules.
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Affiliation(s)
- Yun Hu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
- Department of Immunology, Nanjing Medical University, Jiangsu, China
| | - Na Li
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Peng Jiang
- Department of Thyroid and Breast Surgery, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Liang Cheng
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Bo Ding
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Xiao-Mei Liu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Ke He
- Department of Endocrinology, Wuxi Hospital Affiliated to Nanjing University of Chinese Medicine, Jiangsu, China
| | - Yun-Qing Zhu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Bing-li Liu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Xin Cao
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Hong Zhou
- Department of Immunology, Nanjing Medical University, Jiangsu, China
- Correspondence should be addressed to H Zhou or X-M Mao: or
| | - Xiao-Ming Mao
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
- Correspondence should be addressed to H Zhou or X-M Mao: or
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14
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Januś D, Wójcik M, Taczanowska A, Sołtysiak P, Wędrychowicz A, Roztoczyńska D, Drabik G, Wyrobek Ł, Starzyk JB. Follow-up of parenchymal changes in the thyroid gland with diffuse autoimmune thyroiditis in children prior to the development of papillary thyroid carcinoma. J Endocrinol Invest 2019; 42:261-270. [PMID: 29872995 PMCID: PMC6394764 DOI: 10.1007/s40618-018-0909-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 05/30/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE To present the outcomes of ultrasound (US) follow-ups in children with autoimmune thyroid disease who did not have a thyroid nodule on admission but developed papillary thyroid carcinoma (PTC) and to characterize the parenchymal changes in the thyroid gland prior to the development of PTC. METHODS A retrospective thyroid US scan review of 327 patients diagnosed with AIT was performed. Forty patients (40/327, 12.2%) presented nodular AIT variant with a normoechogenic background. Eleven patients (11/327, 3.4%, 11/40, 27.5%) presenting this variant were diagnosed with PTC (nine females-mean age 15.3 years; two males aged 11 and 13 years). In five of 11 patients, the suspicious nodule that was later confirmed to be PTC was detected on the initial US at presentation. For the remaining six females (6/11) who developed PTC during the follow-up, we retrospectively analysed their US thyroid scans and these patients were selected for analysis in this study. RESULTS On admission, the US evaluation revealed an enlarged normoechogenic thyroid gland in three patients and a hypoechogenic thyroid gland with fibrosis as indicated by irregular, chaotic hyperechogenic layers in three patients. No thyroid nodules were identified. Ultrasound monitoring revealed increasing echogenicity of the thyroid parenchyma during the follow-up. PTC developed in a mean time of 4.6 years (1 9/12-7 4/12 years) since referral to the outpatient thyroid clinic and 2.9 years (6/12-6 9/12) since the last nodule-free US thyroid scan. CONCLUSIONS Sonographic follow-up assessments warrant further exploration as a strategy to determine PTC susceptibility in the paediatric population.
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Affiliation(s)
- D Januś
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Krakow, Poland.
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland.
| | - M Wójcik
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland
| | - A Taczanowska
- Department of Pediatric Surgery, University Children Hospital, Krakow, Poland
- Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - P Sołtysiak
- Department of Pediatric Surgery, University Children Hospital, Krakow, Poland
- Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - A Wędrychowicz
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland
| | - D Roztoczyńska
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland
| | - G Drabik
- Department of Clinical Immunology and Transplantation, Institute of Paediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Ł Wyrobek
- Department of Radiology, University Children Hospital, Krakow, Poland
| | - J B Starzyk
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland
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15
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Radetti G, Loche S, D'Antonio V, Salerno M, Guzzetti C, Aversa T, Cassio A, Cappa M, Gastaldi R, Deluca F, Vigone MC, Tronconi GM, Corrias A. Influence of Hashimoto Thyroiditis on the Development of Thyroid Nodules and Cancer in Children and Adolescents. J Endocr Soc 2019; 3:607-616. [PMID: 30820486 PMCID: PMC6389351 DOI: 10.1210/js.2018-00287] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 12/28/2018] [Indexed: 11/19/2022] Open
Abstract
It is unclear whether patients with Hashimoto thyroiditis (HT) are predisposed to develop thyroid nodules and/or thyroid cancer. The objective of our study was therefore to assess the prevalence of thyroid nodules and/or cancer in patients with HT and to look for possible prognostic factors. A retrospective survey of 904 children/adolescents with HT (709 females, 195 males) regularly followed in nine Italian centers of pediatric endocrinology was performed. Median period of follow-up was 4.5 years (1.2 to 12.8 years). We evaluated free T4, TSH, thyroid peroxidase antibody (TPOAb), thyroglobulin antibodies, and thyroid ultrasound yearly. One hundred seventy-four nodules were detected, with an annual incidence rate of 3.5%. Ten nodules were malignant (8 papillary and 2 papillary follicular variant), giving a 5.7% prevalence of cancer among patients with nodules. The severity of hypoechogenity at ultrasound, TPOAb, and free T4 serum concentrations were predictive for the appearance of new nodules. Furthermore, a positive correlation was observed between TPOAb titer and the development of thyroid cancer. In conclusion, HT seems to influence the development of thyroid nodules, but not cancer in children and adolescents.
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Affiliation(s)
| | - Sandro Loche
- Ospedale Pediatrico Microcitemico, A. Cao, Cagliari, Italy
| | | | | | | | - Tommaso Aversa
- Department of Pediatrics, University of Messina, Messina, Italy
| | | | - Marco Cappa
- Department of Pediatric Endocrinology, Bambino Gesù Children Hospital, Roma, Italy
| | | | - Filippo Deluca
- Department of Pediatrics, University of Messina, Messina, Italy
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16
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Pediatric differentiated thyroid carcinoma: The clinicopathological features and the coexistence of Hashimoto's thyroiditis. Asian J Surg 2019; 42:112-119. [DOI: 10.1016/j.asjsur.2017.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 09/25/2017] [Accepted: 10/17/2017] [Indexed: 11/21/2022] Open
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17
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Liang J, Zeng W, Fang F, Yu T, Zhao Y, Fan X, Guo N, Gao X. Clinical analysis of Hashimoto thyroiditis coexistent with papillary thyroid cancer in 1392 patients. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 37:393-400. [PMID: 29165434 PMCID: PMC5720867 DOI: 10.14639/0392-100x-1709] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 07/07/2017] [Indexed: 11/23/2022]
Abstract
Papillary thyroid carcinoma (PTC) is the most common malignant tumour of the thyroid. The effect of the concurrent presence of Hashimoto's thyroiditis (HT) and PTC is still under debate. The aim of this study is to investigate the influence of coexistent HT on prognostic outcomes and the association of coexistent HT with clinicopathological features. The demographic and clinicopathological data of 1,392 patients who underwent surgery in our hospital from 2007 to 2016 was collected and analysed. Among 1,392 PTC patients, the rate of HT was 25.6%. There were significant differences in the mean levels of thyroid stimulating hormone (3.27 vs. 2.41 μIU/L, p < 0.01), thyroperoxidase antibodies (110.31 vs. 131.2 U/ml, p < 0.01) and thyroglobulin antibodies (131.90 vs. 113.53 ng/ml, p < 0.01) between the two groups. PTC patients with HT had the following characteristics compared to patients without HT: smaller tumour size (p < 0.01), female predominance (p < 0.01) and higher rate of multifocality (p = 0.024). In addition, patients with HT had a significantly lower rate of lymph node metastasis (LNM) and advanced TNM stage than patients without HT (all p < 0.01). Multivariate analysis found that both age and multifocality were significantly associated with central LNM in HT patients (p < 0.01, p = 0.019, respectively). Extrathyroidal invasion and TSH level were also significant independent factors for lateral LNM in HT patients (p < 0.008, p = 0.04, respectively). HT is associated with a significantly higher risk of PTC. The coexistence of HT in PTC patients is associated with favourable clinical outcomes compared to PTC without HT. Total thyroidectomy and prophylactic central compartment lymphadenectomy should be a choice for PTC patients with HT.
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Affiliation(s)
- J Liang
- Department of Head and Neck Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Liaoning Province, People's Republic of China
| | - W Zeng
- Department of Head and Neck Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Liaoning Province, People's Republic of China
| | - F Fang
- Department of Head and Neck Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Liaoning Province, People's Republic of China
| | - T Yu
- Department of Radiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Liaoning Province, People's Republic of China
| | - Y Zhao
- Department of Head and Neck Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Liaoning Province, People's Republic of China
| | - X Fan
- Department of Head and Neck Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Liaoning Province, People's Republic of China
| | - N Guo
- Department of Head and Neck Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Liaoning Province, People's Republic of China
| | - X Gao
- Department of Head and Neck Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Liaoning Province, People's Republic of China
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18
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Won JH, Lee JY, Hong HS, Jeong SH. Thyroid nodules and cancer in children and adolescents affected by Hashimoto's thyroiditis. Br J Radiol 2018; 91:20180014. [PMID: 29595320 PMCID: PMC6221765 DOI: 10.1259/bjr.20180014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/13/2018] [Accepted: 03/28/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To investigate the rates of thyroid nodules and cancer in pediatric cases of Hashimoto's thyroiditis (HT) in Korea. METHODS We retrospectively reviewed 89 pediatric and adolescent patients (age, 3-18.0 years) with HT who underwent thyroid ultrasonography (US) at our institution from February 2006 to July 2016. The diagnosis of HT was based on the presence of thyroid autoantibodies. The presence of any thyroid nodules with US and cytopathologic features was analyzed. The malignancy rate was also determined. RESULTS Thyroid nodules were in 20 of the 89 patients (22.4%). Eight of these 20 patients (40%) had colloid cysts, two (10%) had nodular hyperplasia, one (5%) had follicular adenoma, and two (10%) had lymphocytic thyroiditis. Seven of the 89 patients (7.9%) were confirmed to have a malignancy, all of which were papillary thyroid carcinoma (PTC); of those, five patients had diffuse sclerosing variant PTC, and two had conventional PTC on pathology. CONCLUSION The prevalence of thyroid nodules in children and adolescents with HT was 22.4%. The malignancy rate of children with HT was 7.9%. The malignancy rate among thyroid nodules was 35%, which is higher than the 26% rate generally reported for children with nodules. Therefore, using thyroid US to survey known or suspected thyroid nodules might be helpful in children and adolescents with HT and may provide further useful diagnostic information. Advances in knowledge: Thyroid US could help to assess HT patients who have known or suspected thyroid nodules.
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Affiliation(s)
- Ji Hye Won
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Ji Ye Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hyun Sook Hong
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sun Hye Jeong
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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19
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Januś D, Wójcik M, Drabik G, Wyrobek Ł, Starzyk JB. Ultrasound variants of autoimmune thyroiditis in children and adolescents and their clinical implication in relation to papillary thyroid carcinoma development. J Endocrinol Invest 2018; 41:371-380. [PMID: 28866751 PMCID: PMC5823967 DOI: 10.1007/s40618-017-0758-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/26/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The prevalence of autoimmune thyroiditis (AIT) and papillary thyroid carcinoma (PTC) is rising in children and adolescents, and the coincidence of AIT and PTC is as high as 6.3-43%. OBJECTIVE To investigate the ultrasound manifestation of AIT in relation to PTC development in paediatric patients. PATIENTS 179 paediatric patients (133 females), mean (SD) age: 13.9 (3.03) years diagnosed with AIT and referred for ultrasound evaluation. Eight patients were diagnosed with PTC (6 females). METHODS Retrospective analysis of thyroid ultrasound scans of patients diagnosed with AIT. Thyroid and autoimmune status was assessed based on TSH, fT4, fT3 and increased aTPO and/or aTG and/or TRAB levels. In patients with PTC, total thyroidectomy was performed. RESULTS Analysis of thyroid US scans revealed that the following five ultrasound variants of AIT were observed in 179 patients: the most common in 35.2%-diffuse thyroiditis with hypoechogenic background and normoechogenic parenchyma, in 30.2%-diffuse thyroiditis with irregular background, in 18.9% nodular variant with normoechogenic background, in 11.7%-micronodulations and in 3.9%-diffuse hypoechogenic background. Eight cases of PTC were diagnosed in nodular variant of AIT with normoechogenic irregular background. CONCLUSION Patients with AIT and nodular variant with normoechogenic irregular background of the thyroid gland on US scans are in the risk group of developing PTC and should be followed up with regular neck US assessment.
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Affiliation(s)
- D Januś
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Krakow, Poland.
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland.
| | - M Wójcik
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland
| | - G Drabik
- Department of Clinical Immunology and Transplantation, Institute of Paediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Ł Wyrobek
- Department of Radiology, University Children Hospital, Krakow, Poland
| | - J B Starzyk
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland
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20
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Penta L, Cofini M, Lanciotti L, Leonardi A, Principi N, Esposito S. Hashimoto's Disease and Thyroid Cancer in Children: Are They Associated? Front Endocrinol (Lausanne) 2018; 9:565. [PMID: 30356680 PMCID: PMC6189282 DOI: 10.3389/fendo.2018.00565] [Citation(s) in RCA: 14] [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: 07/27/2018] [Accepted: 09/05/2018] [Indexed: 12/18/2022] Open
Abstract
Hashimoto's thyroiditis (HT) is the most common cause of thyroid disease in children and adolescents. Along with significant modifications of thyroid function, HT in pediatric age can be accompanied by relevant thyroid structural alterations. Over time, benign thyroid nodules, carcinoma and, rarely, primary non-Hodgkin lymphoma can develop. However, the relationships between HT and neoplasms are poorly defined. The main aim of this paper is to discuss what is presently known regarding the coexistence of HT and thyroid tumors. Moreover, we attempt to define the pathogenesis of cancer development in children with HT. Literature analysis showed that despite its rarity and relatively promising prognosis, thyroid cancer is associated with HT. Although not all reasons for the coexistence of these diseases are clearly defined, children with HT should be considered at higher risk for thyroid cancer development. Strict correlations between high levels of serum TSH and anti-thyroid antibodies with cancer must be remembered. The same is true for the presence of nodules, especially if multiple nodules are present and ultrasonography and thyroid fine needle aspiration cytology should be promptly used in uncertain cases.
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Affiliation(s)
- Laura Penta
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università Degli Studi di Perugia, Perugia, Italy
| | - Marta Cofini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università Degli Studi di Perugia, Perugia, Italy
| | - Lucia Lanciotti
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università Degli Studi di Perugia, Perugia, Italy
| | - Alberto Leonardi
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università Degli Studi di Perugia, Perugia, Italy
| | | | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università Degli Studi di Perugia, Perugia, Italy
- *Correspondence: Susanna Esposito
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Carvalho KS, Grunwald T, De Luca F. Neurological Complications of Endocrine Disease. Semin Pediatr Neurol 2017; 24:33-42. [PMID: 28779864 DOI: 10.1016/j.spen.2016.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The endocrine system is a complex group of organs and glands that relates to multiple other organs and systems in the body with the ultimate goal of maintaining homeostasis. This complex network functions through hormones excreted by several glands and released in the blood, targeting different body tissues and modulating their function. Any primary disorders affecting the endocrine glands and altering the amount of hormones synthesized and released will lead to disruption in the functions of multiple organs. The central nervous system of a developing child is particularly sensitive to endocrine disorders. A variety of neurological manifestations have been described as features of several endocrine diseases in childhood. Their knowledge may contribute to an early diagnosis of a particular endocrine condition, especially when more typical features are not present yet. In this article, we discuss specific neurological manifestations found in various endocrine disorders in children.
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Affiliation(s)
- Karen S Carvalho
- From the Section of Neurology, St. Christopher's Hospital for Children, Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA.
| | - Tal Grunwald
- Section of Endocrinology and Diabetes, St. Christopher's Hospital for Children, Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA
| | - Francesco De Luca
- Section of Endocrinology and Diabetes, St. Christopher's Hospital for Children, Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA
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