Malignancy in Pediatric Hyperfunctioning Thyroid Nodules: A Case Report and Literature Review.
Cristina Clausi, Simona Censi, Jacopo Maria Arnone et al.
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Case in brief
A 12-year-old boy presented with a left-sided thyroid nodule following cervical swelling. Laboratory tests indicated suppressed TSH levels, while fT4 and fT3 were normal. Imaging revealed a progressively enlarging hyperfunctioning nodule. Fine-needle aspiration cytology was classified as TIR2. Surgical excision confirmed an angioinvasive encapsulated follicular carcinoma with papillary features, and molecular analysis identified a pathogenic variant in the GNAS gene.
What made this case unusual
This case is notable for the diagnosis of angioinvasive encapsulated follicular carcinoma in a hyperfunctioning thyroid nodule, which is exceptionally rare in the pediatric population.
Diagnostic / clinical pearl
Clinicians should maintain a high index of suspicion for malignancy in pediatric hyperfunctioning thyroid nodules, especially when imaging reveals suspicious features.
Why it matters
Understanding the potential for malignancy in hyperfunctioning thyroid nodules in children is crucial for appropriate management and risk stratification.