Nódulos tiroideos en pediatría: predictores de malignidad / Pediatric thyroid nodules: predictors of malignancy

Introducción: La caracterización de los nódulos tiroideos en pediatría no ha sido aún bien comunicada. El riesgo de malignidad es mayor que en adultos por lo que requieren una evaluación exhaustiva. Objetivo: caracterizar una cohorte de pacientes pediátricos con nódulos tiroideos e identificar predictores de malignidad. Pacientes y métodos: se analizaron los hallazgos demográficos, clínicos, bioquímicos, ecográficos y citológicos de una cohorte prospectiva de 106 pacientes <19 años que consultó por nódulo tiroideo a nuestro centro entre 2008-2017. 89 pacientes alcanzaron el diagnóstico de nódulo benigno o maligno por cirugía y 17 luego de un seguimiento clínico mínimo de 2 años. Retrospectivamente se analizaron las diferencias entre los nódulos benignos y malignos. Resultados: la edad mediana fue 13,9 años, con franco predominio de mujeres puberales. 88% presentó una función tiroidea normal. 88/106 nódulos fueron benignos. El carcinoma papilar de tiroides (CPT) fue la única lesión maligna hallada (17%). El análisis estadístico mostró una asociación significativa de CPT con TSH >2,5mU/l, nódulo sólido, márgenes irregulares, microcalcificaciones y adenopatías cervicales patológicas. Un resultado citológico Bethesda V/VI tuvo un valor predictivo (VP) positivo de 87,5% y VP negativo de 96,4%. Conclusiones: El nódulo tiroideo en pediatría es más frecuentemente maligno. La evaluación sistemática permitió identificar ciertos hallazgos clínicos, bioquímicos, ecográficos y citológicos predictores de malignidad que deben ser considerados al decidir el enfoque diagnóstico

Introduction: Published data on pediatric thyroid nodule´s characterization is scarce. With higher risk of malignancy than in adults, they require an exhaustive diagnostic work-up. Objective: To characterize a pediatric cohort with thyroid nodules to identify predictors of malignancy. Patients and methods: Demographic, clinical, biochemical, ultrasonographical and cytological data were analyzed prospectively in 106 patients <19 years that consulted with a thyroid nodule to our center (2008-2017). 89 patients reached final diagnosis (benign or malignant nodule) after surgery and 17 after a minimum follow-up of 2years. Differences between benign and malignant nodules were analyzed retrospectively. Results: median age was 13.9 years, with predominant pubertal females. 88% was euthyroid. 88/106 nodules were benign. Thyroid papillary carcinoma (TPC) was the only malignancy found (17%). Statistical analysis showed significant association of TPC with TSH levels >2.5mU/l, solid nodules, irregular margins, microcalcifications and pathologic adenopathies. Cytological results Bethesda V/VI showed positive and negative predictive values of 87.5% and 96.4% respectively. Conclusions: Pediatric thyroid nodules are more frequently malignant. The systematic evaluation of our cohort allowed the identification of clinical, biochemical ultrasonographical and cytological predictors of malignancy that have to be considered when deciding the diagnostic approach

Differentiated Thyroid Cancer in Children: Prevalence and Predictors in a Large Cohort with Thyroid Nodules Followed Prospectively.

We retrospectively analyzed the findings of a prospective cohort of 75 children referred for thyroid nodules between 2008 and 2013. Prevalence of papillary differentiated thyroid carcinoma was 18.7%. Thyrotropin >2.5 mIU/L, multinodular goiter, solid nodules, irregular margins, and pathologic lymphadenopathies were identified as independent predictors of malignancy.

Acute effects of testosterone infusion on the serum luteinizing hormone profile in eumenorrheic and polycystic ovary syndrome adolescents.

CONTEXT: Little is known about the neuroendocrine effects of androgens on the GnRH-LH unit in females. OBJECTIVE: Our objective was to evaluate androgen negative feedback on the GnRH-LH axis in eumenorrheic and polycystic ovary syndrome (PCOS) adolescents. DESIGN AND SETTING: We conducted a prospective, longitudinal, randomized, double-blind study at a pediatric endocrinology clinical research center. PARTICIPANTS: Seven nonobese PCOS adolescents and seven matched controls (C) were studied in the early follicular phase of three consecutive menstrual cycles or in three consecutive months. INTERVENTION: Pulsatile LH release was determined during saline [baseline (B)] and constant testosterone (T) infusions: low dose (T-LD) 0.75 and high dose (T-HD) 2.5 mg/12 h iv. Blood samples were drawn every 20 min overnight. MAIN OUTCOME MEASURES: LH (immunofluorometric assay) and T (electrochemiluminescence immunoassay) were determined at B, and during both T-LD and T-HD. LH profiles were analyzed by deconvolution and approximate entropy analyses. RESULTS: On T-LD, C and PCOS serum T levels increased 2- to 3-fold vs. B. On T-HD, T values doubled in both groups vs. T-LD. Controls on T-LD had greater 12-h pulsatile LH secretion rate (P < 0.05 vs. B) and on T-HD had lower mean, pulsatile, basal LH release and LH approximate entropy (vs. B, P < 0.05). PCOS did not respond to T-LD. High-dose T did not alter mean LH in PCOS but increased pulsatile and reduced basal LH secretion. CONCLUSIONS: PCOS adolescents have impaired suppression of pulsatile LH secretion rate consistent with reduced androgen negative feedback. Attenuation of T feedback in nonobese adolescents with PCOS extends the pathophysiology of this syndrome.

The relationship between affective decision-making and theory of mind in the frontal variant of fronto-temporal dementia.

Structural brain imaging and neuropsychological data implicate the orbital aspects of prefrontal cortex in the developing neuropathology of fvFTD. Damage to this region is associated with deficient performance on laboratory tasks assessing theory of mind (ToM) and affective decision-making (DM), but the relationship between these two capacities in patients with prefrontal cortex dysfunction is unclear. We studied a group of patients with early/mild fvFTD (n=20) and a group of matched normal controls (n=10) on the Iowa gambling task (IGT) of affective decision-making, and the "reading the mind in the eyes" (MIE) and "faux pas" (FP) tests of ToM. The fvFTD group was impaired in both ToM tasks and the IGT. While performance measures from the two ToM tasks were significantly correlated, they were not associated with IGT performance. This suggests that whilst similar prefrontal circuitry is implicated in ToM and DM tasks, these cognitive domains may be independent. In clinical settings, the IGT may be useful as a complementary tool to the frontal test battery for patients with early/mild fvFTD. Deficits in decision-making and ToM observed in this study have distinct but additive effects upon the development of social behaviour in patients with prefrontal dysfunction.