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Children and Youth Issues

1. If a teenager has one nodule on each lobe of the thyroid greater in size than 2cm and if a FNAB comes back indeterminate, would you recommend a total thyroidectomy? How is the situation different, if at all, for teens with nodules as compared to adults?

   Ezzat (Oct 1/09)
   A solid thyroid nodule of 2cms or more is of concern and particularly in a teenager. Benign causes of thyroid nodule formation typically present during adult years. Conversely, the presence of a significant thyroid nodule in a teenager who grew up with sufficient iodine in their diet raises questions about its nature. It should definitely be aspirated for cell examination so that a decision regarding surgical removal can be made.
   
   Cheng (Oct 1/09)
   Yes, I would suggest a total thyroidectomy. Age is an important risk factor for thyroid malignancy such that young patients (<20 yrs) and older patients (>60 yrs) have a higher risk of a nodule being malignant. In addition, an indeterminate FNAB result suggests that the cells seen were not obviously benign (and not obviously malignant) and therefore, the level of suspicion is high enough to warrant a total thyroidectomy.