CYSTIC THYROID LESIONS IN CHILDREN

Background/Purpose: Cystic lesions of the thyroid encompass a wide and heterogeneous group of disease states in children, ranging from benig n purely cystic entities to malignant tumors. The purpose of this stud y was to study both the presentation and management of cystic thyroid lesions in the pediatric population. Methods: A retrospective review o f all thyroid masses presenting between 1978 and 1996 and found to be purely or partially cystic on ultrasound examination was conducted, lo oking at presentation, family history, laboratory values, ultrasound s can and radionuclide imaging, and pathological and cytological evaluat ion. Results: Twenty-four patients (19 girls, 5 boys) aged 6 to 18 yea rs received the diagnosis of cystic lesions of the thyroid. Of these, 23 presented with painless neck masses, 21 were clinically euthyroid, only one had a single abnormal thyroid function test, only two had mil dly positive antithyroid antibody test results, and nearly 30% had a p ositive family history of thyroid disease. Ultrasonography showed pure cysts in five patients and mixed solid cystic lesions in 19 patients. On scintiscan, six lesions were hot, 13 were cold, three showed norma l uptake, and two were mixed. Treatment included either observation, a spiration, cyst sclerosis, surgery, or combinations thereof. Pathologi cal and cytological results included follicular adenoma (n = 9), cysti c degeneration (n = 6), multinodular goiter (n = 4), carcinoma (n = 2) , branchial cleft cyst (n = 1), and undetermined (n = 2). Conclusions: Thyroid cysts are often thought to represent benign degenerative dise ase. Our study, which is the first in the literature to specifically a ddress thyroid cysts in children, shows that ultrasound scan is useful in evaluating thyroid masses, whereas laboratory and radionuclide are of less value, and that single lesions of mixed echogeneity are likel y to represent neoplasms, a significant percentage of which are malign ant. Copyright (C) 1998 by W.B. Saunders Company.