Thyroid Nodule/Differentiated Thyroid Carcinoma in the Pediatric Population

Quantitative ultrasound imaging parameters in patients with cancerous thyroid nodules: development of a diagnostic model

OBJECTIVE

This study aimed to develop a diagnostic model utilizing quantitative ultrasound parameters to accurately differentiate benign from malignant thyroid nodules.

METHODS

A retrospective analysis of 194 patients with thyroid nodules, encompassing 65 malignant and 129 benign cases, was performed. Clinical data, ultrasound characteristics, and hemodynamic indicators were compared. Receiver operating characteristic (ROC) curves and logistic regression analysis identified independent diagnostic markers.

RESULTS

No significant differences in clinical data were observed between the groups (P>0.05). Malignant nodules, however, were more likely to exhibit solid composition, hypoechoicity, irregular shapes, calcifications, central blood flow, and unclear margins (P<0.05). Hemodynamic parameters showed that malignant nodules had lower end-diastolic volume (EDV) but higher peak systolic velocity (PSV), resistive index (RI), and vascularization flow index (VFI) (P<0.001). Independent diagnostic factors identified included calcification, margin definition, RI, and VFI. A risk prediction model was formulated, demonstrating significantly lower scores for benign nodules (P<0.0001), achieving an ROC area of 0.964.

CONCLUSION

Color Doppler ultrasound effectively distinguishes malignant from benign thyroid nodules. The diagnostic model emphasizes the importance of calcification, margin clarity, RI, and VFI as critical elements, enhancing the accuracy of thyroid nodule characterization and facilitating informed clinical decisions.

Comparison of ultrasonography and pathology features between children and adolescents with papillary thyroid carcinoma

Objective

To compare the ultrasonography and pathology features between children and adolescents with papillary thyroid carcinoma (PTC).

Methods

A total of 53 patients who were surgically diagnosed with childhood or adolescent PTC between 2017 and 2022 were included in this study. The pre-operative ultrasonography, post-operative histology, and molecular and clinical characteristics were retrospectively analyzed.

Results

No differences were observed in composition, echogenicity, and shape using ultrasonography. Moreover, there was a significantly higher rate of extrathyroidal extension, punctate echogenic foci, and lymph node metastases in children compared to adolescents. The molecular analysis showed that BRAF^V600E mutations are the most prevalent abnormality in adolescent PTC (12/20, 60.0%). However, they are less in childhood PTC (7/23, 30.4%). In addition, using next-generation sequencing, three cases with oncogenic fusion (one TRIM33-RET case, one CCDC6-RET case, and one STRN-ALK case) were identified in childhood PTC.

Conclusion

The frequency of extrathyroidal extension, punctate echogenic foci, and lymph node metastases were higher in childhood PTC, while BRAF^V600E mutations were higher in adolescent PTC.

Clinical Efficacy of Levothyroxine Sodium plus I 131 in the Treatment of Patients with Thyroidectomy and Its Effect on the Levels of Thyroglobulin and Thyrotropin

Objective

This study was to evaluate the clinical efficacy of levothyroxine sodium tablets combined with I 131 in the treatment of patients after thyroidectomy and the effect on thyroglobulin (Tg) and thyroid stimulating hormone (TSH) levels.

Methods

80 patients with differentiated thyroid cancer who required thyroidectomy after surgery between July 2019 and January 2021 were recruited for prospective study, 40 patients in the control group received levothyroxine sodium tablets, and 40 patients in the experimental group received levothyroxine sodium treatment plus I 131 treatment. Treatment effect, serum Tg and TSH levels, and relapse were measured.

Results

The removal rate of residual thyroid tissue in the experimental group (87.50%) was significantly higher than that in the control group (57.50%) (P < 0.05). Levothyroxine sodium tablets plus I 131 was associated with a significantly higher efficacy versus levothyroxine sodium tablets (P < 0.05). There were no significant differences in the serum Tg levels between the two groups before treatment (P > 0.05). After treatment, the serum Tg levels in both groups were significantly decreased, and levothyroxine sodium tablets plus I 131 resulted in a significantly lower Tg level versus levothyroxine sodium tablets (P < 0.05). Before treatment, the two groups showed similar TSH levels (P > 0.05). After treatment, patients receiving levothyroxine sodium tablets plus I 131 had a significantly greater increase in the TSH levels versus levothyroxine sodium tablets (P < 0.05). The recurrence rate of the experimental group was lower than that of the control group (P < 0.05).

Conclusion

Levothyroxine sodium tablets plus I 131 for post-operative patients with differentiated thyroid cancer enhance the removal rate of residual thyroid tissue, effectively reduce serum Tg level, and increase TSH level, with significant therapeutic effects, low recurrence rates, and a high safety profile.