Validating the Modified McGill Thyroid Nodule Score for Assessment of Preoperative Risk of Pediatric Thyroid Malignancy.

OBJECTIVE: The McGill Thyroid Nodule Score (MTNS) is a preoperative tool used to predict the risk for well-differentiated thyroid cancer in adults. It was developed by a multidisciplinary team using established evidence-based risk factors for thyroid cancer. The modified McGill Thyroid Nodule Score (mMTNS) was developed to predict malignancy risk in children. A pilot study suggested the mMTNS was able to assess malignancy risk in children with indeterminate cytology on fine needle aspiration (FNA). This study seeks to validate these findings. METHODS: Retrospective chart review identified subjects who underwent FNA biopsy and subsequent resection. Each patient was assigned a score to compare to final pathology. Statistical analysis was performed with SPSS. All tests were 2-tailed and statistical significance defined p < 0.05. Logistic regression used to determine predictive values of scores. RESULTS: 46 patients ≤21 years of age underwent resection of a thyroid nodule. Female predominance of 85% (n = 39). 78% (n = 36) of patients had palpable nodule. 65% (n = 30) found to have benign pathology and 35% (n = 16) found to have malignancy. Malignant nodules associated with greater mean mMTNS compared to benign [13.63 vs 7.23]. An mMTNS greater >12 had sensitivity of 86.7%, specificity of 90.3%, positive predictive value of 81.3%, and negative predictive value of 93.3%. CONCLUSION: Our data suggests the mMTNS continues to be a useful adjunct in predicting malignancy risk of pediatric thyroid nodules. An mMTNS >12 has a high risk for malignancy, which can aid in counseling and clinical decision making, particularly when there is indeterminate cytology on FNA. LEVEL OF EVIDENCE: IV.

SUBACUTE THYROIDITIS IN A CHILD.

OBJECTIVE: The objective of this report is to describe the presentation, disease course, and management of subacute thyroiditis (SAT) in children. SAT is a rare cause of thyroiditis in children and can be mistaken for acute suppurative thyroiditis, which may be more common in pediatrics. METHODS: We present a 7-year-old female, who had painful thyroid enlargement, fever, and thyrotoxicosis. RESULTS: Laboratory evaluation showed high white blood count, erythrocyte sedimentation rate, and free thyroxine levels. Thyroid-stimulating hormone was low. A computed tomography scan of the neck showed intrathyroidal fluid collection consistent with an abscess. She was treated with clindamycin, with no relief of fever and pain. Thyroid ultrasound showed diffuse enlargement of the thyroid lobes with hypoechoic areas, and no fluid accumulation, consistent with SAT. She was treated with intravenous ketorolac with relief of pain and fever, but these symptoms recurred when she was changed to oral ibuprofen. Her symptoms resolved with prednisolone at 1 mg/kg. CONCLUSION: Based on the limited number of reports in the literature, SAT in children appears to be unusual and may be less common than acute bacterial thyroiditis. In pediatric practice it is important to make the distinction between SAT and acute bacterial thyroiditis.