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    Evaluate thyroid nodules for possible cancer

    Thyroid cancer ranks as the eighth most frequently diagnosed cancer in the pediatric age group and the second most common cancer among teenaged girls aged 15 to 19 years. Overall, unfortunately, the incidence of thyroid cancer has been increasing.

    In a session titled “Thyroid nodules: When Is it cancer and what to do?” on Saturday, October 22, Harvey Chiu, MD, provided practical information for pediatricians who find a new thyroid nodule of unknown significance. His talk included information from the first-ever guidelines for management of a child with thyroid nodules or differentiated thyroid cancer that were developed by the American Thyroid Association Guidelines Task Force on Pediatric Thyroid Cancer.

    “Although only a small percentage of thyroid nodules in children turn out to be cancer, vigilant pediatricians are at the front line for enabling early detection and allowing patients to get proper care,” said Chiu, associate clinical professor of Pediatrics, Division of Pediatric Endocrinology, David Geffen School of Medicine at the University of California, Los Angeles.

     

    “In fact, detection of a suspicious nodule leading to diagnosis of thyroid cancer is very often made by an astute pediatrician while conducting a physical examination for school or athletics participation,” he pointed out.

    Chiu noted that the new pediatric guidelines on thyroid nodules and cancer are much less evidence based than the updated adult guidelines that were developed in parallel, although ongoing studies are rapidly increasing understanding of pediatric thyroid cancer.

    Chiu said that ultrasound is the imaging technique of choice for diagnostic evaluation. He cautioned pediatricians to be vigilant for malignancy in the context of a suspicious history, such as in a child with prior radiation exposure. “Ultimately a diagnosis rests with a biopsy,” he said.

    In contrast to recommendations for adults, there are no recommendations about size or other ultrasound characteristics that would exclude a child from undergoing biopsy of a suspicious thyroid nodule. When a biopsy is indicated, pediatricians have a role in providing counseling that can allay anxiety about the procedure itself and the possibility of a cancer diagnosis.

    “Patients can be reassured that the procedure is typically a simple outpatient procedure that is often well tolerated. Our practice uses a no-needle technique for providing the anesthetic to help allay much of the initial anxiety. For the fine-needle aspiration, we use a 25- or 27-gauge needle, which is thinner than the needles used for a typical blood draw, and do the biopsy under ultrasound guidance,” said Chiu.

    Patients also can be told that with early detection and appropriate management, differentiated thyroid cancer has a good prognosis.

    “Thyroid cancer is a slowly evolving tumor with a 30-year survival rate that exceeds 90%. While today we still may not cure thyroid cancer, we can expect patients to live and age well with their disease,” Chiu said.


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