Clinical immunological and pathological study of thyroid swellings in children and their management

ABSTRACT

Thyroid swellings in childhood pose an important diagnostic and therapeutic problem. The study was conducted to determine the different causes of thyroid swellings in children in Alexandria and their management; and to evaluate the different noninvasive diagnostic tools. Thirty three patients [22 girls and 11 boys][mean age 10.5 +/- 3.6 years] presenting with thyroid swellings and 13 healthy children [8 girls and 5 boys] were included in the study. Serum total triiodothyronine [RIA], total thyroxine [RIA], thyroid stimulating hormone [RIA], and antithyroid peroxidase [TPO] antibodies [ELISA] were measured in all subjects. The thyroid gland was scanned using real time high resolution ultrasonography. Histopathologic examination was performed in 17 cases treated surgically. Fifteen patients [45.5%] had diffuse goitre while solitary and multiple nodules were present in 30.3% and 24.2% of the patients, respectively. Chronic lymphocytic thyroiditis [CLT] constituted the most common cause of goitre [36.4%], followed by Graves' disease [12.1%], simple colloid goitre [12.1%], dyshormonogenesis [9.1%], follicular adenoma [9.1%], simple multinodular goitre [9.1%], papillary carcinoma [6.1%], simple cyst [3%], benign teratoma [3%], and amyloidosis [3%]. Serum antiTPO antibodies were positive in 83.3% and 75% of patients with CLT and Graves' disease, respectively, but negative in all other conditions. Ultrasonography gave an accurate differentiation between nodular [solitary or multiple] and diffuse disease. All subjects with hyperthyroid goitre were due to Graves' disease. CLT and dyshormonogenesis were responsible for the hypothyroid goitre. Sixty percent of solitary thyroid nodules were due to focal CLT and follicular adenoma. Papillary carcinoma represented 20% of these nodules. Appropriate surgery was performed mainly in nodular goiter