American Academy of Pediatrics – Section on Endocrinology

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October 2, 2017

Avoid routinely ordering thyroid ultrasounds in children who have simple goiters or autoimmune thyroiditis.

Limit this study to children who have asymmetric thyroid enlargement, palpable nodules, or concerning cervical lymphadenopathy. Ultrasound can detect nodules that elude palpation, and one prospective series found that 31.5% of patients with Hashimoto’s thyroiditis will have thyroid nodules [2]. The majority of these lesions, however, are not harmful. Overuse of ultrasonography results in needless health care costs and time expenditures for families. More importantly, insignificant findings can create anxiety within patients and parents who are fearful of thyroid cancer. In some cases, the abnormal findings will lead to additional radiographic studies, fine needle aspiration, or aggressive treatment of “pseudo-disease” that will not improve the health of patients.

There is a known association of thyroid cancer with Hashimoto’s thyroiditis, and a pathologic diagnosis of papillary carcinoma was made in 3% of patients in the study cited above [2]. However, there is insufficient evidence to conclude that detecting nodules before they are palpable leads to better outcomes [1]. It seems prudent, therefore, to perform a careful annual physical exam of the thyroid, as recommended for all children who are at are at increased risk of thyroid cancer [2]. If that exam reveals asymmetry, palpable nodules or significant cervical adenopathy then ultrasonography is indicated [2].


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Academy of Pediatrics’ Section on Endocrinology (SOEn) consists of pediatric endocrinologists, pediatricians, and allied health care professionals who are actively involved in some aspect of the study of endocrinological disease in infants, children and adolescents. SOEn strives to inform pediatricians, parents, communities and policy makers on endocrinological disease in children. Thus, the Executive Committee of SOEn was queried to develop a list of on diagnostic and management decisions that have resulted in patient harm either from a misdiagnosis or inappropriate therapy. The list was shared with membership of the Section on Endocrinology for feedback and then finalized by the SOEn Executive Committee. These five clinical issues are the result. Consensus on the items was received from 20 AAP expert groups. The list was critically reviewed and approved by the AAP Executive Committee.

AAP’s disclosure and conflict of interest policy can be found at www.aap.org.

Sources

Corrias A, Cassio A, Weber G, et al. Study Group for Thyroid Diseases of the Italian Society for Pediatric Endocrinology and Diabetology: Thyroid Nodules and Cancer in Children and Adolescents Affected by Autoimmune Thyroiditis. Arch Pediatr Adolesc Med. 2008;162(6):526-531.

Francis G, Waguespack S, Bauer A, et al. Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer: Thyroid. 2015 Jul 1; 25(7): 716–759.