Thyroid Nodules |Symptoms & Causes
甲状腺结节的症状是什么？
Most children with thyroid nodules feel fine and have no symptoms.
While symptoms may vary from child to child, the most common include:
- 脖子上可见的肿块
- a sensation of a lump in the throat when swallowing (or more rarely, difficulty with swallowing)
- unexplained hoarseness
一种罕见的甲状腺结节，称为自主结节（也称为“有毒结节”或“热结节”）会产生过多的甲状腺激素。这可能会引起症状：
- 减肥
- feeling too hot or sweaty
- 心悸(心跳加速、冲击或“skipping beats”)
- tremor of the hands
- 频繁的排便
- difficulty concentrating
自主结节通常是良性的，但是需要进行特殊评估来确定甲状腺结节是否为这种类型。
Keep in mind that similar symptoms can be associated with more common medical problems and conditions. Therefore, it is important to consult your child’s physician for a diagnosis if your child has one of these symptoms.
What causes thyroid nodules?
The causes of thyroid nodules in children are mostly unknown. Some factors that may increase the risk of developing thyroid nodules include exposure to radiation (such as from medical treatments) and certain genetic conditions that cause thyroid nodules or thyroid cancer. What causes some children to develop thyroid nodules and thyroid cancer is an area of activeresearchin our Thyroid Center.
- Exposure of the thyroid to radiation, including radiation used to treat other cancers, increases the risk of developing thyroid nodules and thyroid cancer. Some other childhood cancers that are sometimes treated with radiation that may affect the thyroid include leukemias, lymphomas, brain tumors, and neuroblastomas, as well as cancers that require a bone marrow transplant. The younger a child is when exposed to radiation, the more the risk of thyroid nodules and cancer is increased.
- Thyroid nodules and cancer can occur as part of certain genetic conditions. Some of these conditions may be inherited (familial), and some can occur just in the child without being present in the parents. Some genetic syndromes that increase the risk of thyroid nodules and cancer include:
- PTEN hamartoma tumor syndrome可能包括大头之类的功能；血管畸形；神经发育障碍；以及许多器官的肿瘤，包括皮肤，乳房，子宫和甲状腺。甲状腺结节和甲状腺癌可能发生在6岁的PTEN突变患者中。（PTEN综合征还包括其他几种综合症，例如Cowden综合征，Bannayan-Riley-Ruvalcaba综合征和Proteus综合征）。
- DICER1综合征increases the risk of several types of tumors, including tumors of the lungs (often in infancy), ovaries, kidneys, and thyroid.
- 家族性腺瘤性息肉病（FAP）causes the growth of numerous polyps (abnormal growths or tumors) in the gastrointestinal tract. It also causes an increased risk of other tumors, including thyroid cancer.
- Multiple endocrine neoplasia type 2 (MEN2)is a familial condition that causes medullary thyroid cancer, sometimes in childhood or even infancy, as well as tumors of the adrenal glands (pheochromocytomas) and sometimes the parathyroid glands.
- Familial medullary thyroid carcinoma (FMTC)是一种与MEN2相似的髓质甲状腺癌的家族形式，除了不会引起任何其他类型的肿瘤。
Sometime a lump in the neck that seems like a thyroid nodule is actually athyroglossal duct cyst, which is a fluid-filled sac caused by an abnormality in how the thyroid forms during a baby’s development in the womb. Other types of neck masses and cysts sometimes can also be mistaken for thyroid nodules. Careful evaluation by an experienced team is necessary for suspected thyroid nodules, because thyroglossal duct cysts and other neck masses are evaluated and managed differently than true thyroid nodules.
Thyroid Nodules |诊断和治疗
How are thyroid nodules diagnosed?
Thyroid nodules in children should be evaluated by a physician with special expertise in this area, usually a pediatric endocrinologist. In addition to taking a medical history and performing a physical exam, the doctor may order certain tests.
- Blood testsare used to determine if the thyroid is working properly, or excessively.
- Ultrasoundis the best imaging technique to visualize a known or suspected thyroid nodule. Ultrasound uses sound waves to assess the location and characteristics of nodules in the thyroid gland. Because ultrasound uses only sound waves, it does not expose the patient to any harmful radiation.
- Fine-needle aspiration(sometimes called a biopsy) uses a very thin needle to take a sample of a thyroid nodule. A pathologist examines the cells in the sample to determine whether the nodule may be athyroid cancer。并非所有甲状腺结节都需要活检。如果医生确定需要活检，则可以在超声检查的同一天进行，几乎总是没有镇静。
- Nuclear medicine imagingis used in some cases to determine if a thyroid nodule is producing too much thyroid hormone. Such autonomous nodules (also known as “toxic” or “hot” nodules) are usually benign (not cancer).
- Surgeryis sometimes needed to determine whether a thyroid nodule is a thyroid cancer, if the result of fine-needle aspiration (biopsy) is not definitive.
- Genetic testingmay be recommended in some cases when thyroid nodules occur as part of a possible genetic condition.
How are thyroid nodules treated?
Treatment of a thyroid nodule will vary depending on the results of the evaluation.
Observationmay be appropriate for thyroid nodules that do not require biopsy, or for nodules that are biopsied and found to be benign. Periodic ultrasounds may be recommended to monitor these nodules for changes, and additional biopsies may be needed in the future if changes are seen.
Surgerymay be recommended to remove thyroid nodules that have abnormal biopsy results that suggest a possible thyroid cancer, or nodules that cause bothersome symptoms (like difficulty swallowing).
- 叶切除术is removal of one-half of the thyroid that contains a nodule.
- 叶切除术may be appropriate to remove nodules that have a low risk of being cancer, including benign nodules that are removed just because they cause symptoms.
- 叶切除术is a relatively quick and safe procedure, and most patients do not need to take thyroid medication afterward.
- Total thyroidectomy是去除整个甲状腺。
- Total thyroidectomy is usually appropriate for nodules that have a high risk of being cancer.
- Lifelong treatment with thyroid medication is needed after total thyroidectomy.
- This procedure is generally safe but rarely can have serious complications. For this reason, it is important that the procedure be performed by an experienced thyroid surgeon. Our thyroid surgeons have extensive experience in pediatric thyroid surgery and work closely with the rest of theThyroid Centerteam to provide seamless, coordinated care before, during, and after surgery.
Autonomous nodulesare usually benign. Their treatment depends on how much thyroid hormone they produce, and on whether this is causing symptoms of thyroid hormone excess.
- 略有活跃且没有治疗的自主结节通常不会观察到任何症状。
- Nodules that are very overactive or that cause symptoms can be treated with medication, surgery, or (in patients over 18 years) radioactive iodine ablation.
Our approach to treating autonomous nodules is slightly different than that recommended by the American Thyroid Association, which recommends surgery for all autonomous nodules in children. Our 15_approach is based on our extensive experience with this condition — which was published after the release of the American Thyroid Association guidelines — showing that with careful evaluation, some autonomous nodules can be managed safely without surgery.
Thyroglossal duct cysts和其他颈部肿块的管理不同于甲状腺结节，通常通过手术去除。