Choosing Wisely:

Avoid routinely ordering thyroid ultrasounds in children who have simple goiters or autoimmune thyroiditis.

Rationale and Comments: Limit this study to children who have asymmetric thyroid enlargement, palpable nodules, or concerning cervical lymphadenopathy. Ultrasound can detect nodules that elude palpation, and one prospective series found that 31.5% of patients with Hashimoto’s thyroiditis will have thyroid nodules. The majority of these lesions, however, are not harmful. Overuse of ultrasonography results in needless health care costs and time expenditures for families. More importantly, insignificant findings can create anxiety within patients and parents who are fearful of thyroid cancer. In some cases, the abnormal findings will lead to additional radiographic studies, fine needle aspiration, or aggressive treatment of “pseudo-disease” that will not improve the health of patients. There is a known association of thyroid cancer with Hashimoto’s thyroiditis, and a pathologic diagnosis of papillary carcinoma was made in 3% of patients in the study cited above. However, there is insufficient evidence to conclude that detecting nodules before they are palpable leads to better outcomes. It seems prudent, therefore, to perform a careful annual physical exam of the thyroid, as recommended for all children who are at increased risk of thyroid cancer. If that exam reveals asymmetry, palpable nodules, or significant cervical adenopathy, then ultrasonography is indicated.
Sponsoring Organizations:
  • American Academy of Pediatrics – Section on Endocrinology
  • Sources:
  • Expert consensus
  • Disciplines:
  • Endocrinologic
  • Pediatric
  • References: • Corrias A, Cassio A, Weber G, et al. Study Group for Thyroid Diseases of the Italian Society for Pediatric Endocrinology and Diabetology: Thyroid Nodules and Cancer in Children and Adolescents Affected by Autoimmune Thyroiditis. Arch Pediatr Adolesc Med. 2008;162(6):526-531.
    • Francis G, Waguespack S, Bauer A, et al. Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer: Thyroid. 2015 Jul 1; 25(7): 716–759.

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