(1012) Diagnostic Etiology of Pediatric Thyroid Nodules: A Tertiary Children’s Hospital Institutional Review

Introduction: Pediatric thyroid nodules have been found to carry a greater risk of malignancy compared to adults and have had a significant increase in incidence over the last 20 years. Very little is known about why there is an increase in incidence or how these nodules are being identified. Our study is designed to analyze how nodules are identified and diagnosed by different specialties and how that impacts the management of patients.

Methods: We performed a retrospective chart review of all pediatric patients aged 0 to 17 with at least one thyroid nodule diagnosed between 2017 and 2023 at a pediatric tertiary care hospital. Diagnosing provider, nodule diameter, nodule evaluation methodology, biopsy results, surgical decision, and surgical pathology results were reviewed and underwent statistical analysis.

Results: We identified 262 pediatric patients with thyroid nodules from 2017-2023. The largest portion of thyroid nodules were initially diagnosed by pediatricians (40.5%, N = 106), with radiologists diagnosing the second most (30.5%, N = 80). The rest of the initial diagnoses were performed by endocrinologists (11.5%, N = 30), surgeons (5.3%, N = 14), and other providers (12.2%, N = 32). Pediatricians were significantly more likely to diagnose the nodules with a physical exam (67%, N = 71) compared to all specialties (p = 0.019). Incidental imaging via radiology was significantly more likely to diagnose smaller thyroid nodules when compared to pediatricians (0.7 cm vs. 1.55 cm, p < 0.001) and endocrinologists (0.7 cm vs 1.15 cm, p < 0.001). The larger nodules diagnosed by endocrinologists and pediatricians were significantly more likely to be biopsied (p = 0.002) and treated surgically (p < 0.005) when compared to nodules diagnosed via incidental imaging.

Conclusions: This study is one of the first to look at the etiology of diagnosis of pediatric thyroid nodules, which is important given the significant increase in incidence of pediatric thyroid cancer over the past 20 years. Given that pediatricians are diagnosing these nodules most often, it emphasizes their importance and the utility of their physical exam.