Surgery of the Thyroid in Children: Current Trends in Practice

2016 ◽  
Vol 7 (2) ◽  
pp. 57-63
Author(s):  
Alanna M Windsor ◽  
Eleanor P Kiell ◽  
Eric E Berg ◽  
Ken Kazahaya
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Surgery ◽  
Thyroid Disease ◽  
Thyroid Nodules ◽  
Pediatric Patients ◽  
Task Force ◽  
Pediatric Population ◽  
American Thyroid Association ◽  
Thyroid Function Tests ◽  
Current Trends

ABSTRACT Thyroid surgery in the pediatric population is performed for a variety of benign and malignant conditions, including thyroid nodules, hyperthyroidism, goiter, and thyroid cancer. Thyroid nodules, though uncommon in children, are more likely to be malignant than in adults and require careful evaluation with history, imaging, thyroid function tests and often ultrasoundguided biopsy to determine which nodules will require further interventions. The treatment of thyroid malignancy is primarily surgical, though the extent of surgery is an area of active debate. Moreover, thyroid surgery in children may have a higher rate of complications, and a number proposals have been suggested to mitigate these risks. The guidelines developed by the 2015 American Thyroid Association Guidelines Task Force on Pediatric Thyroid Cancer are a helpful tool in directing the medical and surgical management of these complex patients, and provide a method for stratification of patient risk for recurrent disease. Children with thyroid disease are recommended to be cared for using a multidisciplinary approach and by providers and facilities experienced in management of pediatric patients. Surgery should be performed by surgeons experienced in pediatric cervical procedures. The objective of this review is to describe the range of thyroid disease affecting pediatric patients, examine current diagnostic algorithms, and discuss common treatment approaches, including the role for both surgery and adjunctive therapies. How to cite this article Windsor AM, Kiell EP, Berg EE, Kazahaya K. Surgery of the Thyroid in Children: Current Trends in Practice. Int J Head Neck Surg 2016;7(2):57-63.

scholarly journals Review of American Thyroid Association guidelines for the diagnosis and management of thyroid disease during pregnancy and the postpartum

2018 ◽  
Vol 14 (3) ◽  
pp. 128-139
Author(s):  
Valentin V. Fadeyev
Keyword(s):  
Thyroid Disease ◽  
Critical Appraisal ◽  
Clinical Decision Making ◽  
Task Force ◽  
Synthesis Methods ◽  
American Thyroid Association ◽  
Thyroid Function Tests ◽  
Diagnosis And Management ◽  
Published Evidence ◽  
In Pregnancy

Thyroid disease in pregnancy is a common clinical problem. Since the guidelines for the management of these disorders by the American Thyroid Association (ATA) were first published in 2011, significant clinical and scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid disease in women during pregnancy, preconception, and the postpartum period. The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations. The guideline task force had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. The revised guidelines for the management of thyroid disease in pregnancy include recommendations regarding the interpretation of thyroid function tests in pregnancy, iodine nutrition, thyroid autoantibodies and pregnancy complications, thyroid considerations in infertile women, hypothyroidism in pregnancy, thyrotoxicosis in pregnancy, thyroid nodules and cancer in pregnant women, fetal and neonatal considerations, thyroid disease and lactation, screening for thyroid dysfunction in pregnancy, and directions for future research. We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid disease in pregnant and postpartum women. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with these disorders.

scholarly journals Thyroid nodules: a review of current guidelines, practices, and prospects

2008 ◽  
Vol 159 (5) ◽  
pp. 493-505 ◽  
Author(s):  
H Gharib ◽  
E Papini ◽  
R Paschke
Keyword(s):  
Clinical Practice ◽  
Thyroid Disease ◽  
Thyroid Nodules ◽  
Rating Scale ◽  
Task Force ◽  
American Thyroid Association ◽  
Practice Recommendations ◽  
Joint Task ◽  
Joint Task Force ◽  
Current Guidelines

In 2006, two major society-sponsored guidelines and one major consensus statement for thyroid diagnosis and management were published by: the American Association of Clinical Endocrinologists/Associazione Medici Endocrinologi (AACE/AME); the American Thyroid Association (ATA); and the European Thyroid Association (ETA). A careful review of these guidelines reveals that despite many similarities, significant differences are also present, likely reflecting differences in practice patterns, interpretation of existing data, and availability of resources in different regions. The methodology of the guidelines is similar, but a few differences in the rating scale make a rapid comparison of the strength of both evidence and recommendations difficult for the use in current clinical practice. Some recommendations are based mostly on experts' opinion. Thus, a same recommendation may be based on a different evidence; on the other hand, sometimes the same evidence may induce a different recommendation. Therefore, efforts are needed to produce a few high-quality clinical studies to close the evidence gaps in the still controversial fields of thyroid disease and to create a joint task force of the most authoritative societies in the field of thyroid disease in order to reach a common document for clinical practice recommendations.

scholarly journals Malignancy Analyses of Thyroid Nodules in Patients Subjected to Surgery with Cytological- and Ultrasound-Based Risk Stratification Systems

Endocrines ◽  
2020 ◽  
Vol 1 (2) ◽  
pp. 102-118
Author(s):  
Stefania Giuliano ◽  
Maria Mirabelli ◽  
Eusebio Chiefari ◽  
Margherita Vergine ◽  
Rita Gervasi ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Risk Stratification ◽  
Clinical Features ◽  
Fine Needle Aspiration ◽  
Thyroid Surgery ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
American Thyroid Association ◽  
Fine Needle ◽  
Indeterminate Cytology

The fine needle aspiration (FNA) cytology is the gold standard for the preoperative diagnosis of thyroid cancer. However, up to 30% of FNA examinations yield nondiagnostic or indeterminate results and this complicates patient management. Clinical features and ultrasound (US) patterns, including US risk stratification systems, could be useful in the preoperative diagnostic workup and prediction of malignancy, but the evidences are not univocal. Methods: 400 consecutive patients subjected to thyroid surgery were retrospectively enrolled at our institution in Calabria, Southern Italy. Preoperative US and FNA cytological descriptions, formulated according to the “Italian consensus for reporting thyroid fine-needle aspiration cytology” (ICCRTC) classification and three US risk stratification systems (those developed by the American Association of Clinical Endocrinologists, American College of Endocrinology and Associazione Medici Endocrinologi (AACE/ACE/AME), American Thyroid Association (ATA), and American College of Radiology (ACR-TIRADS)), were collected, along with histological results. Results: 147 thyroid cancer cases, in large majority papillary carcinomas, were detected on final histological examination. Almost two-thirds of patients subjected to thyroid surgery for either benign or malignant lesions were female. Patient’s age ≤20 years and between 21–30 years were clinical features associated with increased risk of thyroid cancer in logistic regression analyses. US features associated with thyroid cancer included irregular margins, solid composition, microcalcifications, and marked hypoechogenicity. The AACE/ACE/AME, ATA, and ACR-TIRADS risk categories, corresponding to specific US patterns, were strong predictors of malignancy in both genders, but not in nodules with indeterminate cytology. A measured difference between the longitudinal (L) and the anteroposterior (AP) diameter >5 mm, a proxy for a parallel-oriented oval shape of a nodule, emerged as a robust protective factor against thyroid cancer (OR 0.288 (95%CI 0.817–0.443); p < 0.001), regardless of cytological risk. Conclusions: Some, but not all, well-established predictors of TC have been confirmed in this study. Controversy surrounds the diagnostic performance of US risk stratification systems for the detection of thyroid cancer in the subgroup of nodules with indeterminate cytology, suggesting their use only to set the thresholds for FNA. A measured difference between L and AP diameters >5 mm may represent an additional and practical tool for ruling out malignancy in thyroid nodules, with the potential to reduce unnecessary surgical procedures.

The Accuracy of ACR TI-RADS Classification of Neck Ultrasound as a First-Line Diagnostic Approach for Thyroid Neoplasms in Pediatric Patients: A Retrospective Study

2018 ◽  
Vol 5 (1) ◽  
pp. 13-23
Author(s):  
Nikolai S. Grachev ◽  
Elena V. Feoktistova ◽  
Igor N. Vorozhtsov ◽  
Natalia V. Babaskina ◽  
Ekaterina Yu. Iaremenko ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Pediatric Patients ◽  
Thyroid Neoplasms ◽  
Diagnostic Methods ◽  
Diagnostic Approach ◽  
First Line ◽  
Neck Ultrasound

Background.Ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) is the gold standard in diagnosing the pathological nature of undetermined thyroid nodules. However, in some instances limitations and shortcomings arise, making it insufficient for determining a specific diagnosis.Objective.Our aim was to evaluate the effectiveness of ACR TI-RADS classification of neck ultrasound as a first-line diagnostic approach for thyroid neoplasms in pediatric patients.Methods.A retrospective analysis was made of FNA and US protocols in 70 patients who underwent the examination and treatment at Dmitry Rogachev National Research Center between January 2012 and August 2017. In the retrospective series 70% (49/70) of patients undergone FNA and 43% (30/70) of them undergone repeated FNA. All US protocols were interpreted according to ACR TI-RADS system by the two independent experts. The clinical judgment was assessed using the concordance test and the reliability of preoperative diagnostic methods was analized.Results.According to histologic examination protocols, benign nodules reported greater multimorbidity 29% (20/70), compared with thyroid cancer 17% (12/70), complicating FNA procedure. A statistically significant predictor of thyroid cancer with a tumor size ACR TI-RADS showed a significant advantage of ACR TI-RADS due to higher sensitivity (97.6 vs 60%), specificity (78.6 vs 53.8%), positive predictive value (87.2 vs 71.4%), and negative predictive value (95.7 vs 41.2%). Concordance on the interpreted US protocols according to ACR TI-RADS classification between two experts was high, excluding accidental coincidence.Conclusion.The data support the feasibility of US corresponding to the ACR TI-RADS classification as a first-line diagnostic approach for thyroid neoplasm reducing the number of unnecessary biopsies for thyroid nodules.

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