Thyroid nodules in childhood‐onset Hashimoto's thyroiditis: Frequency, risk factors, follow‐up course and genetic alterations of thyroid cancer

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.

Case Report: Solid variant of papillary thyroid carcinoma in a young adult with Turner syndrome with chronic thyroiditis

“…Chronic thyroiditis, reported in 24−55% of patients with TS (7, 23), is reported to be associated with SVPTC (9, 10, 15) or PTC displaying prominent stromal desmoplasia and marked fibrosis (18, 24, 25), which are the pathological characteristics of SVPTC. In previous studies, thyroid nodules were detected in 13−18.8% of patients in the ultrasound follow-up of chronic thyroiditis, and PTC was observed in 10.3−22.5% of those with nodules (19,20,26). Chronic thyroiditis has been suggested to be related to thyroid malignancy, including PTC, but the exact mechanism remains Frontiers in Oncology frontiersin.org unclear (5).…”

“…Accumulation of further genetic pathogenesis of SVPTC is required. Besides, chronic thyroiditis, linked with an increased risk of development of differentiated thyroid carcinoma (7,(18)(19)(20), could be associated with SVPTC without a notable history of exposure to radiation (9, 10). TS is characterized as an X chromosomal abnormality and is often accompanied by chronic thyroiditis (2,3).…”

Hashimoto’s Thyroiditis and the Risk of Papillary Thyroid Cancer in Children

“…However, few studies have examined clinicopathologic characteristics and patient outcomes-such as the present study. Published data are mixed, with some suggesting that HT leads to more aggressive thyroid cancers [30,34,35], and other data suggesting that it makes no difference-or that HT may be protective [23,36,37].…”

Considerations for Balance Between Fundamental Treatment and Improvement of Quality of Life of Pediatric Thyroid Cancer Patient: Comparative Analysis With Adult Using Propensity Score Matching

“…South Korea is an iodine-rich country; therefore, thyroid function tests are frequently performed, even on children. Thus, there are many cases in which thyroid cancer is diagnosed at an early stage through tests, such as ultrasound ( 14 ). At the pediatric endocrine clinic, when testing growth hormone in children, a thyroid function test is also performed.…”