Thyroid Nodule In Children And Adolescents Case Studies

CASE: John Smith is an 11 year old Asian boy with PMHx of hypothyroidism x 2 years, on levothyroxine 25 mcg daily presented with painful progressively enlarging goiter that started 2 months ago. The pain is described as constant shooting and radiating to the neck, rated 6/10, nothing made it better, moving his neck made it worse. Pt states that the pain is mostly localized to the right, and it is associated with compressive symptoms like difficulty breathing and swallowing, but no change in voice. The swelling was painful and progressive and at the time of examination was 2 × 2 cm on the right side of the neck and was moving with deglutition. She had no other complaints and her family history was noncontributory. Pt denies chills, fever, SOB, palpitation.

Thyroid nodule refers to an abnormal growth of thyroid cells that forms a lump within the thyroid gland. Thyroid nodules are less common in children and adolescents than in adults, the prevalence of palpable thyroid nodules in childhood is about 1.5% and 4-7%.1, 2 in adulthood. In children, 26% of thyroid nodule are malignant, while in adults

The diagnostic steps for thyroid nodules in children and adolescents are not different from those in adults. A thyroid nodule can be discovered by a physician during a routine physical examination, discovered by patients themselves, or observed incidentally during imaging of the neck. However, the majority (75%) of pediatric patients with both benign and malignant nodules have asymptomatic neck masses 3. While some children with enlarged thyroid may present with symptoms of hypothyroidism which included bradycardia, fatigue, dry skin, decreased appetite, weight gain, hyperhidrosis, constipation, and tremors and cold intolerance, other may present with symptoms of hyperthyroidism which include tachycardia, weight loss with increased appetite, heat intolerance and increased sweating, diarrhea, and exophthalmia, some are