Thyroid nodules (TN) are rare in children; however, the risk of malignancy is significantly higher than in the adult population: 26% versus 5%. The aim of this study was to analyze the clinical, radiological, and histological features of thyroid nodules in children and to discuss therapeutic approaches.

This is a retrospective study including 41 children and adolescents managed for thyroid nodules between 2004 and 2022.

The average age was 14 years. The sex ratio (M/F) was 0.28 with a marked female predominance. The most common reason for consultation was the appearance of an anterior lower neck mass. Ultrasound showed a mean nodule size of 3.35cm. Nodules were classified as EuTIRADS II, III, IV, and V in 10, 21, 6, and 4 patients, respectively. Suspicious cervical lymphadenopathy was found in 12% of cases. Ultrasound-guided fine-needle aspiration (FNA) of the thyroid nodule was performed in 5 patients, and lymph node FNA in 2 patients. Twenty-six patients underwent a lobo-isthmectomy, while 15 underwent total thyroidectomy performed in a single stage in 12 cases and in two stages in 3 cases due to inconclusive frozen section results. Twelve patients (29%) underwent mediastino-recurrential lymph node dissection, with additional functional neck dissection in 5 patients (12%). Final histopathological examination confirmed papillary thyroid carcinoma in 12 patients. These patients were started on suppressive-dose hormone therapy and referred for radioactive iodine therapy.

The management of pediatric thyroid nodules relies on a thorough evaluation of the risk of malignancy, enabling optimal treatment approaches.