Purpose or Case Report: Diffuse thyroid disease (DTD) encompasses a spectrum of thyroid disorders, including autoimmune conditions such as Hashimoto's thyroiditis (HT). The association between HT and thyroid carcinoma remains controversial. Particularly in children, a robust, large-scale investigation is lacking, and the nature of this potential correlation and outcomes remains poorly elucidated.
The aim of this study is to evaluate the US features of the thyroid gland and cervical lymph nodes, the clinical characteristics and outcomes of pediatric patients with DTD and thyroid carcinoma (TC).
Methods & Materials: This is a retrospective analysis of pediatric and adolescent patients (age <18 years) diagnosed with DTD based on the US findings from January 2014 to October 2024. US characteristics of the thyroid gland and cervical lymph nodes were assessed. Thyroid nodules were assigned an ACR TI-RADS score. Results from histopathology and patients' characteristics and outcomes were included. Descriptive statistical analysis was performed.
Results: 250 children and adolescents were diagnosed with DTD based on the US findings [201 females (mean age: 12.8 y; range: 0.1–18 y)]. 89(35.6%) had benign thyroid nodules and 17(6.8%) developed thyroid carcinomas (15 females; mean age 14.8 years; range: 10–17 y) who underwent total thyroidectomy. The mean follow-up from the initial US to cancer diagnosis was 28.3 months. In the cancer group, 15 patients had at least one nodule, 5(29.4%) TI-RADS 4, and 10(58.8%) TI-RADS 5. The classical variant of papillary thyroid carcinoma was the most frequent histological subtype, found in 7(41.1%). The follicular and diffuse sclerosing variants were each identified in 2(11.7%). The ones with diffuse sclerosing variants exhibited a diffusely infiltrative pattern, but no distinct nodule. Extrathyroidal extension was noted in 4(27%), and metastatic lymphadenopathy was present in 6(35%). One showed distant metastases. Cancer patients were followed for a mean of 34.7 months with only one nodal recurrence treated surgically. Non-cancer patients with DTD were followed for a mean of 22 months.
Conclusions: There was increased malignancy in our pediatric cohort with diffuse thyroid disease highlighting the importance of close US monitoring for those patients with DTD and a palpable abnormality. Coexisting DTD and thyroid carcinoma showed no significant effect on our patient’s outcomes.