Aim This study aimed to report a case of malignancy in a series of 17 autonomous thyroid nodules in children/adolescents. Methods We performed a retrospective analysis of patients with thyroid nodules between 2003 and 2018 who had the following characteristics: (i) low serum thyroid stimulating hormone (TSH); (ii) nodule(s) > 1 cm on ultrasonography; (iii) homogenous uptake on scintigraphy with radioiodine in the area corresponding to the nodule(s); (iv) suppression of the remaining parenchyma; and (v) age ≤ 18 years. The approach of the institution was to perform fine‐needle aspiration in all children/adolescents with autonomous thyroid nodules, as well as surgery in all patients of this age group with toxic nodular disease. Results Thirteen patients, 11 girls and 2 boys aged 9–18 years, had 17 autonomous nodules ranging in size from 1.4 to 5.5 cm. Cytology was benign in 11 nodules (64.7%) and histology confirmed the benign nature in all of them. Two nodules (11.7%) had non‐diagnostic cytology and were also benign. Cytology was indeterminate in three other nodules (17.6%), with two adenomas and one follicular tumour of uncertain malignant potential. Finally, cytology was suspicious for malignancy in only one nodule (5.9%) for which the infiltrative follicular variant of papillary thyroid carcinoma was confirmed. The patient was a 13‐year‐old girl whose nodule exhibited highly suspicious ultrasonography features. Conclusion The incidence of malignancy in this series of 17 autonomous thyroid nodules in children/adolescents was 5.9%.

Background The risk of malignancy in autonomous thyroid nodules is considered to be very low in adults and fine‐needle aspiration (FNA) is not recommended in these cases; however, some studies contest this. Just as ultrasonography (US) has been used to select nonautonomous nodules with initial benign cytology that deserve FNA repetition, this method may also be useful to select autonomous nodules that are candidates for FNA. Methods In this prospective study, FNA was obtained in 48 adults patients with autonomous solitary nodules >1 cm with suspicious US features (at least two of the following findings: hypoechogenicity, microcalcification, irregular margins, taller than wider shape, predominantly or exclusively central vascularization). Results Cytology was benign in 28 patients (58.3%). Six patients (12.5%) had nondiagnostic cytology and histology revealed benign nodules in these cases. Cytology was indeterminate in nine other patients (18.5%). Of these, seven were adenomas and two were follicular carcinomas on histology. Finally, cytology suspicious for malignancy or malignant cytology was detected in five patients (10.4%), all of them confirmed histologically to be papillary carcinomas (the follicular variant in three). Thus, the frequency of malignancy was 14.6% (two follicular carcinomas and five papillary carcinomas), 8.3% in nodules with two suspicious findings vs 33.3% in nodules with ≥3 suspicious findings (P = .055). Conclusion The results suggest that the presence of ultrasonographic findings suspicious for malignancy in autonomous thyroid nodules >1 cm is a criterion for the indication of FNA.

ResumoDe acordo com as Novas Diretrizes Curriculares Nacionais da Graduação Médica (NDCN) e sua orientação para uma postura crítica e reflexiva do acadêmico realizou-se a oficina "Bases curriculares e Medicina de Família e Comunidade" durante o IV Congresso Mineiro de Medicina de Família e Comunidade (IVCMMFC), em Belo Horizonte -MG, 12 de junho de 2009. A oficina tratou sobre a inserção da especialidade, Medicina de Família e Comunidade (MFC), na graduação, discutindo os métodos de ensino médico: Aprendizado baseado em problematização (PBL), método integrado de ensino e método tradicional Flexneriano. A oficina foi dividida em três momentos. Primeiramente, foi proposta adequação de algumas definições da literatura médica: Atenção Primária à Saúde, Médico generalista, Médico sanitarista, Especialista em Clínica Médica e Médico de Família e Comunidade. Após, foram discutidas as Novas diretrizes curriculares; o Relatório Flexner e sua influência nos modelos de ensino existentes (tradicional, problematizado e integrado), o momento oportuno para inserção da MFC na graduação e qual método de ensino utilizar. O tema do preconceito contra a especialidade surgiu nas discussões, assim como adequação da MFC e níveis de serviço (primário, secundário e terciário) e como valorizar a especialidade sem ¨super-especializar¨ o estudante. As conclusões levantadas na oficina foram descritas neste documento e apresentadas em plenária ao final do congresso.