Çocukluk çağı tiroid nodüllerine yaklaşım

Öz

Çocuklarda tiroid nodül gelişiminde genetik ve çevresel bir çok faktör rol oynamaktadır. Çocukluk çağında palpe edilebilen tiroid nodül sıklığı %2 olarak bildirilmektedir. Günümüzde ultrasonografinin daha yaygın olarak kullanılması nedeniyle bu oranın %5’ e kadar çıktığını gösteren çalışmalar mevcuttur. Çocukluk çağında tespit edilen tiroid nodüllerinin büyük bir kısmının benign karakterde olmasına karşın erişkin yaş grubu ile kıyaslandığında çocuklarda tiroid nodül malignansi insidansının daha yüksek olduğu bildirilmektedir. Çocukluk çağı tiroid nodüllü olgularda tanı anında uzak metastaz yapma riski ve tedavi sonrası rekürrens riskinin erişkin yaş grubuna göre daha yüksek olması nedeniyle de bu olguların erken tanı ve tedavisi hayati önem arz etmektedir. Günümüzde radyolojik görüntüleme tekniklerinin kullanımının artması, immünohistokimyasal ve moleküler tanı yöntemlerinin gelişmesi tiroid nodüllü olguların erken tanı almasına ve uygun tedavi yönetiminin belirlenmesine yardımcı olmaktadır. Bu yazıda çocukluk çağında tiroid nodül gelişimine yol açan nedenlerle ve malignansiyi telkin eden bulgular irdelenerek güncel tanı ve takip yaklaşımları literatür eşliğinde sunulmuştur.

 

Anahtar Kelimeler

• Çocukluk çağı,tiroid nodül,güncel yaklaşım

Approach to thyroid nodules in childhood

Öz

Many genetic and environmental factors play role in the etiology of thyroid nodules in the childhood. The incidence of palpable thyroid nodules in childhood is known as 2%. There are studies indicating that this incidence is increased to 5% since thyroid ultrasonography is used more commonly. Although most of the thyroid nodules are benign in the children, incidence of malignancy of thyroid nodules in childhood is quite higher than adults. The early diagnosis and treatment of thyroid nodules in childhood is of vital importance since risk of distant metastasis at the time of diagnosis and recurrence rate after treatment is much higher than adult age group. Nowadays, the higher utilization rates of radiological imaging, immunohistochemical and molecular diagnostic techniques help the early diagnosis of the cases and selection of proper therapeutic interventions.   In this paper, predisposal factors and risk factors for malignancy of thyroid nodules in childhood is discussed, treatment and follow-up approach is reviewed with the literature.

Anahtar Kelimeler

• Childhood,current approach,thyroid nodules

Kaynakça

1. 1- Rallison Ml, Dobyns BM, Keating FR Jr, Rall JE, Tyler FH. Thyroid nodularity in children. JAMA 1975; 233: 1069.
2. 2- Niedziella M. Pathogenesis, diagnosis and management of thyroid nodules in children. Endocr Relat Cancer 2006; 13: 427-53.
3. 3- Dinauer CA, Breuer C, Rivkees SA. Differantiated thyroid cancer in children: diagnosis and management. Curr Opin Oncol 2008; 20: 59-65.
4. 4- Gupta A, Ly S, Castroneves LA, et al. A standardized assessment of thyroid nodules in children confirms higher cancer prevalence than in adults. J Clin Endocrinol Metab 2013; 98: 3238.
5. 5- Dean DS, Gharib H. Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab 2008; 22: 901-11.
6. 6- Halac I, Zimmmerman D. Thyroid nodules and cancers in children. Endocrinol Metab Clin North Am 2005; 34: 725-44.
7. 7- Hogan AR, Zhuge Y, Perez EA, Koniaris LG, Lew JI, Sola JE. Pediatric thyroid carcinoma: incidence and outcomes in 1753 patients. J Surg Res 2009; 156-67.
8. 8- Hung W. Solitary thyroid nodules in 93 children and adolescents. A 35 years experience. Horm Res 1999; 52: 15.

9. 9- Corrias A, Mussa A. Thyroid nodules in pedistrics: which ones can be left alone, which ones must be investigated, when and how. J Clin Res Pediatr Endocrinol 2013; 5: 57-69.
10. 10- Önder A, Aycan Z. Approach to thyroid nodules in children and adolescents. Turk J of Pediatr 2014; 56: 219-25.
11. 11- Corrias A, Mussa A, Baronio F, et al. Study Group for Thyroid diseases of Italian Society for Pediatric Endocrinology and Diabetology (SIEDP/ISPED). Diagnostic features of thyroid nodules in pediatrics. Arch Pediatr Adolesc Med 2010; 164: 714-9.
12. 12- Goldfarb M, Gondek SS, Sanchez Y, Lew JI. Clinic-based ultrasound can predict malignancy in pediatric thyroid nodules. Thyroid 2012; 22: 827-31.
13. 13- Corrias A, Cassio A, Weber G, et al. Thyroid nodules and cancer in children and adolescents affected by autoimmune thyroiditis. Arch Pediatr Adolesc Med 2008; 162: 526–31.
14. 14- McLeod DS, Watters KF, Carpenter AD, Ladenson PW, Cooper DS, Ding EL. Thyrotropin and thyroid cancer diagnosis: a systematic review and dose-response metaanalysis. J Clin Endocrinol Metab 2012; 97: 2682–92.
15. 15- Elisei R. Rotine calcitonin measurement in the evaluation of thyroid nodules. Best Pract Res Clin Endocrinol Metab. 2008; 22: 941-53.
16. 16- Francis GL, Waguespack SG, Bauer AJ, et al. Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer. The American Thyroid Association Guidelines Task Force on Pediatric Thyroid Cancer. Thyroid 2015; 25: 716-59.
17. 17- Halac I, Zimmerman D. Thyroid tumors in children. In Liftshitz F. (eds) Pediatric Endocrinology, 5th edition, Informa Healthcare USA Inc. New York, 2007: 455-73.
18. 18- Guille JT, Opoku-Boateng A, Thibeault SL, Chen S. Evaluation and Management of Pediatric Thyroid nodüle. The Oncologist 2015; 20: 19-27.
19. 19- Saavedra J, Deladoey J, Saint-Vil D, et al. Is ultrasonography useful in predicting thyroid cancer in children with thyroid nodules and apparently benign cytopathologic features? Horm Res Paediatr 2011; 75: 269-75.
20. 20- Wharry LI, McCoy KL, Stang MT, et al. Thyroid nodules (>/=4 cm): can ultrasound and cytology reliably exclude cancer? World J Surg 2014: 38; 614-21.
21. 21- Chibas ES, Ali SZ. The Bethesda System for Reporting Thyroid Cytopathology. Thyroid 2009; 19: 1159-65.
22. 22- Baloch ZW, LiVolsi VA Post fine-needle aspiration histologic alterations of thyroid revisited. Am J Clin Pathol 1999; 112: 311-6.
23. 23- Smith M, Pantanowitz L, Khalbuss WE, Benkovich VA, Monaco SE. Indeterminate pediatric thyroid fine needle aspirations: a study of 68 cases. Acta Cytol 2013; 57: 341-8.
24. 24- Monaco SE, Pantanowitz L, Khalbuss WE, et al. Cytomorphological and molecular genetic findings in pediatric fine-needle aspiration. Cancer Cyto-Pathol 2012; 120: 342-50.
25. 25- Stevens C, Lee JK, Sadatsafavi M, Blair GK. Pediatric thyroid fine-needle aspiration cytology: a meta-analysis. J Pediatr 2009; 44: 2184-91.
26. 26- Buryk MA, Monaco SE, Witchel SF, et al. Preoperative cytology with molecular analysis to help guide surgery for pediatric thyroid nodules. Int J Pediatr Otolaryngol 2013; 77: 1697-1700.
27. 27- De Luca F, Tommaso A, Alessi L, et al. Thyroid nodules in childhood: indications for biopsy and surgery. Italian Journal of Pediatrics 2014; 19: 40-8.
28. 28- Corrias A, Mussa A, Wasniewska M, et al. Levothyroxine treatment in pediatric benign nodules. Horm Res Paediatr 2011; 75: 246-51.
29. 29- Yousef A, Clark J, Suhail AR. Thyroxine Suppression Therapy For Benign, Non-Functioning Solitary Thyroid Nodules: A Quality-Effects Meta-Analysis. Clin Med Res. 2010; 8: 150–8.
30. 30- AACE/AME Task Force on Thyroid nodules, American Association of Clinical Endocrinologists and Associazone Medici Endocrinologi Medical Guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract 2006; 12: 63-102.