Ectopic Intrathyroidal Thymus in Childhood: A Sonographic Finding Leading to Misdiagnosis.

BACKGROUND: During gestation, the primordial thymus migrates from the pharynx to the anterior mediastinum, thus thymic tissue can remain at any point along this path. Intrathyroidal thymic remnants are rare, and their sonographic patterns have only recently been described. This retrospective study presents the sonographic appearance of ectopic intrathyroidal thymus and emphasizes the role of sonography in order to avoid misdiagnosis. METHODS: The population consisted of 42 children, 3.5-14 years old, who had a thyroid sonogram performed due to a positive family history or symptoms indicative of thyroid disease, and ectopic intrathyroidal thymus was recognized. RESULTS: In all patients, the same pattern was revealed: a fusiform intrathyroidal lesion, with no mass effect, homogeneously hypoechoic, with diffuse bright internal echoes. The similarity to the characteristic sonographic pattern of the normal mediastinal thymus was crucial for the diagnosis of ectopic intrathyroidal thymic tissue. In 8 cases, a normal elongated thymus was found connected to the thyroid with an accessory lobe embedded in the lower thyroid pole. The above sonographic appearances mimicked a thyroid nodule. CONCLUSIONS: Awareness of the sonographic patterns of the ectopic intrathyroidal thymus is mandatory to avoid misdiagnosis. In most cases, further investigation is unnecessary, but sonographic follow-up should be recommended.

Thyroid autoimmunity in schoolchildren in an area with long-standing iodine sufficiency: correlation with gender, pubertal stage, and maternal thyroid autoimmunity.

BACKGROUND: A strong genetic background and gender are believed to be involved in thyroid autoimmunity (TA). The age these factors become manifest is less clear, however. The objective of the present study was to determine the prevalence of TA in children and adolescents and to determine if there are relationships between the period of onset of TA and gender and between TA and maternal autoimmunity. METHODS: Antithyroperoxidase antibodies (anti-TPO Ab), antithyroglobulin antibodies (anti-Tg Ab), thyrotropin, thyroxine, triiodothyronine, and urinary iodine were determined in 440 healthy schoolchildren (200 boys and 240 girls), aged 5-18 years, and in 123 mothers living in an iodine-replete region. RESULTS: The prevalence of positive anti-TPO and anti-Tg Ab was 4.6% and 4.3%, respectively. In girls, the prevalence of positive anti-TPO Ab was higher in Tanner stage II-V compared to Tanner stage I (8.2% vs. 2.2%; p < 0.05). No difference was detected with regard to anti-Tg Ab. In girls, positive anti-TPO and anti-Tg Ab levels were associated with significantly greater thyroid volume. Hypoechogenicity was detected in 52.6% and 36.8% of the children with positive anti-TPO or anti-Tg Ab, respectively (p = 0.0005). The prevalence of autoimmune thyroiditis, as defined by positive serum anti-TPO and/or anti-Tg and an echographic pattern of the thyroid gland having diffuse or irregular hypoechogenicity, was 2.5%. Mothers of anti-TPO Ab positive children had positive anti-TPO Ab more frequently compared to mothers of anti-TPO Ab negative children (82% vs. 18%; p = 0.0005). Mothers of anti-Tg Ab positive children had positive anti-Tg Ab more frequently compared to mothers of anti-Tg Ab negative children (75% vs. 25%; p = 0.0005). CONCLUSIONS: These findings demonstrate that thyroid antibody positivity in children was significantly associated with maternal autoimmunity and their development in girls emerges at puberty. Since heredity, female gender, and puberty are strongly associated with TA, girls in families with TA should be examined at the onset of puberty.

Thyroid volume and echostructure in schoolchildren living in an iodine-replete area: relation to age, pubertal stage, and body mass index.

BACKGROUND: Thyroid volume (TV) varies between geographical regions. Thus, population-specific references for TV in regions with long-standing iodine sufficiency may be more accurate than a single international reference. AIM: The aim of the study was to determine TV and assess the prevalence of goiter and thyroid nodules in schoolchildren aged 5-18 years living in an iodine-replete area. METHODS: Ultrasonography was used to assess TV and structure in 440 schoolchildren (200 boys and 240 girls) living in the Athens area. Urinary iodine excretion was also measured. Age, body surface area (BSA), body mass index (BMI), and Tanner stage were recorded. RESULTS: TV was significantly correlated with age in boys (r = 0.779, p < 0.0005) and girls (r = 0.669, p < 0.0005), and with BSA in boys (r = 0.730, p < 0.0005) and girls (r = 0.623, p < 0.0005). TV increased with the progress of puberty in boys (Tanner stage I: 3.42 mL; Tanner stage II-V: 7.35 mL; p < 0.0005) and girls (Tanner stage I: 3.74 mL; Tanner stage II-V: 5.99 mL; p < 0.0005). We used the 97th percentile value as the upper limit and calculated the prevalence of goiter to be 3.2%. There was a weak correlation between TV and BMI standard deviation score only in boys (r = 0.166, p = 0.023). Boys in Tanner stage II-V had larger TV than girls had in the same pubertal stage (7.35 mL vs. 5.99 mL, p = 0.001); such a difference was not observed in Tanner stage I. The median urinary iodine was 307.83 microg I/g creatinine, indicating iodine sufficiency. There was a significant inverse correlation between TV and urinary iodine. In 5.1% of the studied subjects one or more nodules were observed, whereas in 4.1% of cases the nodules were accompanied by hypoechogenicity. CONCLUSIONS: In healthy Greek children living in an iodine-replete area, the main determinants of TV in both boys and girls were age, BSA, and pubertal stage. The prevalence of goiter was 3.2% and that of altered echostructure was 9.2%.

Evolution of glucose intolerance and diabetes in transfused patients with thalassemia.

OBJECTIVE: To study the evolution of glucose disturbances (GD) in patients with thalassemia aged 11-30 years. DESIGN AND METHODS: A total of 263 patients, classified into three groups on the basis of age, and period of follow-up ranging from 2-10 years, were studied. Evolution of GD was assessed through serial oral glucose tolerance tests (OGTT), based on WHO criteria. RESULTS: At baseline (11-14 years of age) evaluation of OGTT disclosed a prevalence of 16.3% of impaired glucose tolerance (IGT), and zero for diabetic tolerance (DT). Prevalence of IGT increased progressively up to 39% in the following 4 years, but remained constant during the last 6 years of observation. In contrast, DT had a very low prevalence, beginning with 0.5% at 13-16 years, increasing to 2.4% by the age of 21-24 years. CONCLUSIONS: During puberty and early adolescence impaired glucose tolerance (IGT) was found in a considerable proportion of thalassemics. In contrast, DT was infrequent and progression to DM was slow. Only 12.4% of patients with IGT developed DT within a period of 10 years. Further studies are necessary to identify all of the factors contributing to abnormalities of glucose metabolism in thalassemic patients.