Abstract
Case presentationWe report for the first time a synchronous papillary and follicular thyroid carcinoma in a 12-year-old girl presenting with a large (5 cm diameter) left thyroid nodule, an increased left and right upper pole technetium tracer uptake at scintigraphy and hyperthyroidism. The uptake at the right lobe was explained by the crossing of the left nodule to the right site of the neck at Computed Tomography (CT) scanning.BackgroundAlthough thyroid nodules are less common in children than in adults, there is more vigilance required in children because of the higher risk of malignancy. According to literature, about 5% of the thyroid nodules in adults are malignant versus 20–26% in children. The characteristics of 9 other pediatric cases with a differentiated thyroid carcinoma presenting with a toxic nodule, which have been reported during the last 20 years, are summarized. A nodular size of more than 3.5 cm and female predominance was a common finding.ConclusionsThe presence of hyperthyroidism in association with a hyperfunctioning thyroid nodule does not rule out thyroid cancer and warrants careful evaluation, even in the absence of cervical lymph node invasion.
Highlights
Thyroid nodules are less common in children than in adults, there is more vigilance required in children because of the higher risk of malignancy
The presence of hyperthyroidism in association with a hyperfunctioning thyroid nodule does not rule out thyroid cancer and warrants careful evaluation, even in the absence of cervical lymph node invasion
We reviewed the previously reported differentiated thyroid cancers (DTC) in children and adolescents with a hyperfunctioning thyroid nodule associated with hyperthyroidism, called toxic nodule, to look for common characteristics and potential risk factors for malignancy
Summary
Solitary thyroid nodules are rare in childhood in comparison with adulthood, but have a higher risk of malignancy [1]. We reviewed the previously reported DTC in children and adolescents with a hyperfunctioning thyroid nodule associated with hyperthyroidism, called toxic nodule, to look for common characteristics and potential risk factors for malignancy. Inclusion criteria were detailed case descriptions of children aged below 16 years old with a clinical and biological hyperthyroidism and an underlying differentiated thyroid carcinoma documented at histological examination. Overview of previously reported case reports of DTC in children with a toxic nodule [8,9,10,11,12,13,14,15] All described patients were female except one. Case presentation In a 12-year-old female, presenting with a painless neck swelling since one month, a 5 cm long, non-tender but firm nodule in the left thyroid lobe was detected at physical examination. Results of TSHR gene, GNAS gene and PTEN gene analysis were normal
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