Several studies indicate that in young patients (less than 21 years of age at the time of diagnosis), the prognosis of
thyroid carcinoma (TC) is more favorable than in older patients. However, a more radical treatment approach is recommended in children and adolescents due to the higher prevalence of local lymph-node involvement in these cases. Since the extent of primary surgical treatment is closely related to the overall prognosis, preoperative diagnosis becomes essential in the management of
thyroid neoplasms in young patients. In this retrospective study (1987-1998), we analyzed a surgical series of 50 children and adolescents with
thyroid nodules in an attempt to establish the role of diagnostic studies in detecting malignant lesions prior to surgery. Our diagnostic protocol for evaluating
thyroid nodules was based on clinical evaluation, measurement of
thyroid-hormone and
thyroglobulin (TG) levels, anti-TG and anti-TPO antibody titers,
calcitonin, CEA, and TPA levels, sonography, scintigraphy, and fine-needle aspiration cytology (FNAC) of the
thyroid nodules and any enlarged lymph nodes. Eleven of the 15 cases of histologically confirmed
carcinoma were preoperatively identified as malignant lesions with the aid of FNAC. The authors conclude that the preoperative work-up of children and adolescents with
thyroid nodules requires the collaboration of an experienced team of professionals, and recommend FNAC as the initial test.