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Goiter and thyroid cancer in children

INTRODUCTION

Children may have goiters that are diffuse or nodular, and the goiters may be associated with normal, decreased, or increased thyroid secretion. The causes of goiter in infants, children, and adults are similar, but their relative frequency varies substantially. In the United States, for example, most infants and children with a goiter have chronic autoimmune thyroiditis, whereas among adults nontoxic nodular goiters predominate.

Goiter may be present at birth or detected at any age thereafter. The goiter may be caused by increased thyrotropin (TSH) secretion on account of decreased thyroid hormone secretion; antibodies that activate TSH receptors (Graves' disease) with increased thyroid hormone secretion; or TSH-independent processes, such as inflammation associated with autoimmune thyroiditis, benign and malignant tumors, and infiltrative disease.

Once a goiter is detected, the appropriate diagnostic evaluation and treatment depend on the age of the child, whether thyroid function is perturbed, and the characteristics of the goiter. This topic review will consider congenital and acquired goiters, independent of their function, and in children.

Causes of hyperthyroidism and hypothyroidism in children are discussed separately. (See "Clinical manifestations and diagnosis of hyperthyroidism in children and adolescents" and "Acquired hypothyroidism in childhood and adolescence".)

THYROID SIZE IN INFANTS AND CHILDREN

The mean (±SD) thyroid volume, measured by ultrasonography, in 68 term neonates in Chicago was 0.9 ± 0.2 mL [1]. In an extensive study of 7- to 14-year-old children from an iodine-sufficient area of Italy, the mean thyroid volume increased with age from 3.1 to 6.3 mL (table 1) [2]. Thyroid size correlates with body surface area; among children 6 to 14 years of age, the upper 95th percentile was 6.2 mL per m2 in one series [3]. In a report of 6- to 12-year old children from Japan, where intake of iodine is relatively high (median urinary iodine 281.6 mcg/L), thyroid volumes were smaller, increasing from 1.5 mL to 3.8 mL over this age period [4]. Clinically, we use the "rule of thumb" to evaluate thyroid size in older children: each lobe of the normal thyroid gland is approximately the size of the terminal phalanx of the child's thumb.
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