Search

Background: Thyroid nodules are less common in children than adults, but the risk of malignancy in thyroid nodules is much higher in children. The ability to characterize pediatric thyroid nodules has improved with the use of ultrasound-guided fine-needle aspiration, the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) classification system, and expanded molecular testing. Nevertheless, stratification criteria to predict thyroid malignancy in children are poorly defined. Our objective was to determine if clinical presentation and molecular genetics could predict malignancy in pediatric thyroid nodules., Methods: Retrospective chart review of patients ≤18 years of age at the Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center with the diagnosis of a thyroid nodule from January 2007 to January 2012 was conducted. Eighty-nine subjects fulfilled the inclusion criteria: 1) thyroid nodule ≥0.8 cm and biopsy (n=76), or 2) thyroid nodule ≥0.8 cm, no biopsy, and ultrasound follow-up for at least 2 years (n=13)., Results: Twenty-four (27%) of 89 patients were diagnosed with thyroid cancer (50% papillary thyroid carcinoma [PTC], 50% follicular variant of papillary thyroid carcinoma [FVPTC]). Features associated with malignancy included larger nodule size, palpable nodule, or palpable lymphadenopathy. There were no differences in presenting features between patients with PTC and those with FVPTC. Thyroid malignancy was diagnosed in all nine patients with a molecular abnormality (BRAF, RAS, RET/PTC, PAX8/PPARγ)., Conclusions: Clinical features, FNA cytology, and molecular genetics are valuable tools to discriminate benign from malignant nodules in pediatric patients. This information is important to direct subsequent clinical management.

Objective: To determine the prevalence of constipation among children with tracheostomy tubes compared with children without tracheostomy tubes. We theorize that patients with tracheostomy may be unable to achieve adequate subglottic pressure for the Valsalva maneuver, which may contribute to constipation., Design: Prospective cohort study., Setting: Tertiary care children's hospital., Patients: Consecutive series of 36 children with tracheostomy and 72 general pediatric otolaryngology patients without tracheostomy., Interventions: A pediatric constipation questionnaire (from previously published references) was given to parents of the study participants. Data were collected regarding patient medications, neurological status, and use of positive pressure airway assistance, speaking valves, and feeding tubes. Data were evaluated using chi(2) and t tests. Logistic regression analysis was used to search for independent variables impacting presence of constipation., Results: The mean ages for the tracheostomy and control groups were 6.8 and 4.7 years, respectively (P = .07). A history of constipation was elicited in 60% of children with tracheostomy compared with only 16.7% of controls (P < .001). More patients with tracheostomy tubes (80.0%) than controls (20.8%) were taking medication to treat constipation (P < .001). Constipation was also significantly associated with older age (P = .02), use of medications with constipation as a known adverse effect (P = .02), and the presence of neurodevelopmental impairment (P < .001). Constipation was still independently associated with the presence of a tracheostomy tube when correcting for age and the use of constipation-causing medications. When controlling for neurodevelopmental impairment, the presence of a tracheostomy tube was not proven to be an independent predictor of constipation., Conclusion: Children with tracheostomy tubes are more likely to have a history of constipation, although a causal relationship between tracheostomy and constipation could not be determined due to the potentially confounding variable of neurodevelopmental delay.