Ultrasonography of Various Thyroid Diseases in Children and Adolescents: A Pictorial Essay

Thyroid imaging is indicated to evaluate congenital hypothyroidism during newborn screening or in cases of a palpable thyroid mass in children and adolescents. This pictorial essay reviews the ultrasonography (US) of thyroid diseases in children and adolescents, including normal thyroid gland development, imaging features of congenital thyroid disorders (dysgenesis, [aplasia, ectopy, hypoplasia], dyshormonogenesis, transient hypothyroidism, thyroglossal duct cyst), diffuse thyroid disease (Grave's disease, Hashimoto's thyroiditis, and suppurative thyroiditis), and thyroid nodules. The primary imaging modalities for evaluating thyroid diseases are US and radionuclide scintigraphy. Additionally, US can be used to guide aspiration of detected nodules.

Tiroiditis no-autoinmunes / Non-autoimmune thyroiditis

El término tiroiditis comprende un grupo de enfermedades de la glándula tiroides caracterizado por la presencia de inflamación, abarcando entidades autoinmunes y no-autoinmunes. Pueden manifestarse como enfermedades agudas con dolor tiroideo severo (tiroiditis subaguda y tiroiditis infecciosas), y condiciones en las cuales la inflamación no es clínicamente evidente, cursando sin dolor y presentando disfunción tiroidea y/o bocio (tiroiditis inducida por fármacos y tiroiditis de Riedel). El objetivo de esta revisión es aportar un enfoque actualizado sobre las tiroiditis no-autoinmunes cubriendo sus aspectos clínicos, diagnósticos y terapéuticos.

The term thyroiditis comprises a group of thyroid diseases characterized by the presence of inflammation, including autoimmune and non-autoimmune entities. It may manifest as an acute illness with severe thyroid pain (subacute thyroiditis and infectious thyroiditis), and conditions in which the inflammation is not clinically evident evolving without pain and presenting primarily thyroid dysfunction and/or goiter (drug-induced thyroiditis and Riedel thyroiditis). The aim of this review is to provide an updated approach on non-autoimmune thyroiditis and its clinical, diagnostic and therapeutic aspects.

Importância da ecogenicidade da tireóide no diagnóstico da tireoidite crônica auto-imune: [revisão] / Value of thyroid echogenicity in the diagnosis of chronic autoimmune thyroiditis: [revision]

A tireoidite crônica auto-imune é, atualmente, a principal causa de hipotireoidismo e seu diagnóstico baseia-se nas manifestações clínico-laboratoriais. O marcador laboratorial mais importante é a presença de anticorpos antitireoglobulina e antiperoxidase, sendo este último o teste mais sensível. A biópsia aspirativa apresenta alta sensibilidade e especificidade, porém, é um método invasivo e, por isso, reservado para quando há presença de nódulo ou bócio de crescimento rápido. A cintilografia é desnecessária para o diagnóstico, já que apresenta baixa sensibilidade e especificidade. A ultra-sonografia, tanto ao modo B como ao dúplex-Doppler colorido, evoluiu de forma muito rápida e tornou-se um método simples, não-invasivo, reprodutível e com alta sensibilidade para o diagnóstico da tireoidite crônica auto-imune. Ao modo B, a ecogenicidade é um parâmetro de extrema importância, já que, além de apresentar alta correlação com o quadro citopatológico, também apresenta alta sensibilidade para o diagnóstico da tireoidite crônica auto-imune. Embora este parâmetro não seja específico da tireoidite crônica auto-imune, pois também pode estar presente na doença de Graves, na tireoidite pós-parto e na tireoidite subaguda, tais desordens podem ser facilmente diferenciadas tanto pelo quadro clínico-laboratorial quanto pelo dúplex-Doppler colorido. Assim, este artigo tem o objetivo de revisar a importância do estudo da ecogenicidade no diagnóstico da tireoidite crônica auto-imune.

Chronic autoimmune thyroiditis is currently considered as the main cause for hypothyroidism and its diagnosis is based on clinical manifestations and laboratory tests results. The most significant laboratory marker for this disease is the presence of anti-thyroperoxidase and anti-thyroglobulin antibodies, the latter being the most sensitive one. Aspiration biopsy shows high sensitivity and specificity but, considering the invasiveness of this method it is reserved for cases of suspected nodules or fast growing goiter. Scintigraphy is unnecessary for the diagnosis, considering its low specificity and sensitivity. Both B-mode and duplex color Doppler ultrasonography have rapidly evolved, becoming a simple, noninvasive and reproducible method with high sensitivity for the diagnosis of chronic autoimmune thyroiditis. Echogenicity is a relevant parameter at B-mode ultrasonography because of the close correlation with cytopathological findings besides the high sensitivity in the diagnosis of the disease. Although this is not a specific parameter for chronic autoimmune thyroiditis, considering that it may also be found in Graves' disease, postpartum thyroiditis and subacute thyroiditis, such disorders can be easily differentiated both by clinical-laboratory and duplex color Doppler findings. Thus, the present study is aimed at evaluating the significance of thyroid echogenicity in the diagnosis of chronic autoimmune thyroiditis.

Role of FNAC and antithyroid antibodies in the diagnosis of thyroid disorders.

Multiple parameters are needed to diagnose thyroid disorders. 100 cases of thyroid swellings were studied by clinical assessment, hormonal assay, fine needle aspiration cytology (FNAC), antithyroglobulin (Tg) and antimicrosomal (Tm) antibodies and histopathology. The cases were divided into four groups. Cases of thyroiditis on FNAC showed predominance of lymphocytes (76%), hurthle cells (77%), epithelioid cells and giant cells (31%) and high titres of Tg (66%) and Tm (92%). Non toxic goitre was characterized by colloid and foam cells (100%) and low positivity for Tg and Tm (25%). Toxic goitre showed colloid (30%). Hurthle cells, anisonucleosis of acinar cells (38%), fire flare (62%) and high positivity for Tg and Tm (73%). Neoplasia was diagnosed mainly by cell morphology on FNAC and a low positivity for Tg and Tm (30%). FNAC in correlation with thyroid antibodies is useful in diagnosing autoimmune thyroiditis, goitre, Grave's disease and malignancy of thyroid. Antibodies have a specific role in the diagnosis of early stage of thyroiditis.

Thyroid peroxidase autoantibodies [tpo-ab] determination in pregnancy; its clinical importance

Pregnant women with positive thyroid peroxidase autoantibodies [TPO-Ab] run an increased risk for developing postpartum thyroiditis [PPT]. Eighty clinically healthy pregnant women in third trimester were screened for TPO-Ab titres by radio-immunoassay [RIA] technique and were followed 3-4 months postpartum. During pregnancy TPO-Ab seropositivity was seen in 17.5% cases. Serum thyroxine [T4] and thyroid stimulating hormone [TSH] levels done only in seropositive cases were within normal limits. After follow-up 21.25% cases showed TPO-Ab seropositivity 3-4 months postpartum. The rise in TPO-Ab titre was very significant in 23.5% of seropositive case [5% of the total] who developed mild thyrotoxic phase of PPT. Serum T4levels were increased above normal limits while serum TSH levels were decreased in them along with the clinical findings. Twenty nonpregnant women were included in the study as controls who were all seronegative for TPO-Ab showing significantly high prevalence of TPO-Ab during pregnancy [P<0.001]

Tiroidite pós-parto: prevalência e evoluçäo clínica / Thyroiditis postpartum: prevalency and clinical evolution

A tiroidite pós-parto (TPP) é uma disfunçao tiroidiana, ainda pouco conhecida, que acomete mulheres no 1º ano pós-parto. Estudos em nosso meio sao escassos. Estudamos um grupo de 115 gestantes entre a 16º e 20º semana de gestaçao, quanto a disfunçao tiroidiana (T3, T4, T4L e TSH) e presença de anticorpos antitiroidianos (anti-tireoglobulina e anti-peroxidase tiroidiana). Reavaliamos estas gestantes no 6º mês pós-parto, quanto aos mesmos parâmetros. Encontramos 4/115 (3,4 por cento) portadoras de TPP. Das 12 pacientes que apresentaram AATPO positivo na primeira avaliaçao, duas (16,6 por cento) evoluiram para perda fetal entre o 5º e o 6º mês de gestaçao, três (25 por cento) mantiveram-se eutiroidianas, três (25 por cento) apresentaram hipotiroidismo subclínico e quatro (33,3 por cento) desenvolveram TPP, com diagnóstico realizado através da clínica (queixas de disfunçao tiroidiana) e alteraçao das dosagens hormonais. O sintoma mais comumente apresentado pelas pacientes com TPP foi a fadiga (4/4). Todas as pacientes que desenvolveram TPP apresentaram fatores de risco para tal. Baseados nos resultados encontrados, recomendamos que gestantes com fatores de risco para o desenvolvimento da TPP devam ser monitoradas durante a gestaçao e no período pós-parto quanto ao desenvolvimento de disfunçao tiroidiana.

Lesión tumefacta fibroinflamatoria de cabeza y cuello: primer caso comunicado en México / Head and neck tumefactive fibroinflammatory lesion: first case reported in Mexico

Se comunica por primera vez en México el hallazgo de un caso de "lesión tumefacta fibroinflamatoria de cabeza y cuello". Es una entidad rara, histológicamente benigna y localmente agresiva, descrita por primera vez en 1975, y de la que se han comunicado solamente 22 casos en la literatura mundial. El paciente, masculino de 47 años, presentaba tumor maxilar izquierdo de 4 cm de diámetro, duro, fijo, no doloroso y sin cambios de la piel supra yacente. Una tomografía computada mostró masa hipodensa anterior al seno maxilar izquierdo con destrucción de su pared. Fue sometido a resección total de una masa de color gris, firme, hemogénea, bien delimitada y sin cápsula, compuesta por tejido fibroso maduro, linfocitos y polimorfo nucleares dispersos. Esta lesión semeja tiroiditis de Riedel, mediastinitís fibroesclerosa, colangitis esclerosante y fibrosis retroperitoneal. El paciente se encontraba libre de tumor en una revisión seis meses posterior a su tratamiento

Tiroiditis de Hashimoto asociada a purpura trombocitopenica idiopatica (PTI) / Thyroiditis of Hashimoto associated to idiopathic thrombocytopenic purpura (ITP) / Annual reports 1995

El hipertiroidismo ha sido asociado frecuentemente a desordenes hemorràgico pero la asociaciòn de hipotiroidismo autoinmune y purpura trombocitopenica idiopàtica (PTI) se conoce màs bien a travès de reportes anecdòticos. Es por ello el interès de comunicar un nuevo caso de esta asociaciòn que trata de una niña de 11 años con diagnòstico de PTI tratada con prednisona y posterior esplenectomìa, quien desarrollò tiroiditis de Hashimoto un año postremisiòn completa de la trombopenia.

Common childhood thyroid disorders.

This article presents current knowledge about common childhood thyroid gland disorders. Included are congenital and acquired hypothyroidism, hyperthyroidism, disorders due to iodine deficiency, tumors and miscellaneous conditions. The significance of early diagnosis by screening and institution of treatment of congenital hypothyroidism is emphasized. Etiology, pathogenesis, clinical signs and symptoms, diagnosis and treatment are discussed.

Tiroiditis de Hashimoto asociada a purpura trombocitopenica idiopatica (PTI) / Thyroiditis of Hashimoto associated to idiopathic thrombocytopenic purpura (ITP) / Annual reports 1995

El hipertiroidismo ha sido asociado frecuentemente a desordenes hemorràgico pero la asociaciòn de hipotiroidismo autoinmune y purpura trombocitopenica idiopàtica (PTI) se conoce màs bien a travès de reportes anecdòticos. Es por ello el interès de comunicar un nuevo caso de esta asociaciòn que trata de una niña de 11 años con diagnòstico de PTI tratada con prednisona y posterior esplenectomìa, quien desarrollò tiroiditis de Hashimoto un año postremisiòn completa de la trombopenia

Thyroidite tuberculeuse [a' propos de 3 cas]

In our country, tuberculosis, a social curse, rages on endemic mode. The thyroid localization is exceptional [0,2%] and its clinical manifestation is usually misleading. The positive diagnosis is based on presumptive elements [contagion, other localization of tuberculosis] and the certitude is based on anatomopathology and/or put BK to the fore. We report three cases of confirmed tuberculosis thyroid in endocrinology, diabetology and nutrition service during ten years. The course of illness with treatment has been marked by a rapid amendment of clinical and biological symptomatology and an entire recovery

Isolation of Salmonella paratyphi A from thyroid abscess--a case report.

S. paratyphi A isolated from aberrant site i.e. thyroid abscess which is an unusual manifestation of focal salmonella infection. It is reported for its rare complications.