Research Article
Thyroid Scan and Thyroid Disorders in Adolescent: 5-year Experience
Amal Halim1, Hanan Ahmed Wahbasup1, Hend Ahmed EL-Hadaad1*, Alaa Wafa2, Amro ELhadidi3
and Hosam Halim4
1Clinical Oncology & Nuclear Medicine, Egypt
2Internal Medicine, Egypt
3Department of General Surgery, Faculty of Medicine, Mansoura University, Egypt
4General Surgery, Student Hospital, Mansoura University, Egypt
*Corresponding author: Dr. Hend Ahmed El-Hadaad, Faculty of medicine, University of Mansoura, Egypt
Published: 29 Dec, 2016
Cite this article as: Halim A, Wahba HA, EL-Hadaad
HA, Wafa A, ELhadidi A, Halim H.
Thyroid Scan and Thyroid Disorders
in Adolescent: 5-year Experience. Clin
Oncol. 2016; 1: 1167.
Abstract
Thyroid gland enlargement is a common problem in clinical practice. The clinical presentation and
etiology of thyroid disorders differ substantially in adolescents from that in adults.
Purpose: This study was conducted to describe clinical characteristics of adolescent patients referred
for thyroid scan during 5-years period in Mansoura University Hospital.
Methods: this retrospective study included all adolescent patients referred for thyroid scan during
the period from 2010-2015 in nuclear medicine unit in Mansoura University Hospital. Full history
was taken from each patient including family history. Both general and local examinations were
performed. Thyroid scan was carried out through intravenous injection of 3-5mCi of technetium-99
pertechnetate. Then 20 minutes post injection; anterior and oblique views were acquired on a
gamma camera. Many features of thyroid scan can be found and final diagnosis based on scanning
features and laboratory results.
Results: This retrospective study included 60 adolescent patients referred for thyroid scan. They
were 46 (76.7%) females and 14males (23.3%) with female to male ratio of 3.3:1 Simple multinodular
goitre was the most common finding (46.7%) followed by Graves’disease (25%) then Hashimoto's
disease (11.7%). Ectopic thyroid was reported in 2 female patients (3.3%) Solitary thyroid nodule
was found in 6 patients (10%) with toxic finding in one case and simple in five. Papillary thyroid
carcinoma was diagnosed in 2 female patients (3.3%).
Conclusion: This study is retrospective with relatively small number of patients; so these preliminary
results need to be confirmed through a prospective study with larger number of patients.
Keywords: Thyroid scan; Graves’disease; Hashimoto's disease; Thyroid disorders
Introduction
Thyroid gland is a subject of interest; its enlargement is a common problem in clinical practice
[1]. In our life cycle, puberty is a period of hormonal interactions [2]. So marked changes in function
of thyroid occur during puberty as an adaptation to sexual and body development [3].This can
explain the common occurrence of thyroid disorders during adolescence by incidence of about 3.7%
[4]. The clinical presentation and etiology of thyroid disorders differ substantially in adolescents
from that in adults [5]. Thyroid disorders can presented as goiter, some abnormal symptoms and
physical or laboratory findings [2]. There are some risk factors for development of thyroid diseases
as: female gender, iodine deficiency, head and neck irradiation, age of puberty and family history of
thyroid diseases [6,7]. Many studies reported association between development of thyroid cancer
and exposure to radiation with an average latency time between diagnosis of thyroid cancer and
exposure of 8.5 years [8-12]. Nearly 41% of children with thyroid nodules have a family history of
thyroid disorders [7]. In 1990s, thyroid scintigraphy was used to differentiate between functioning
and non-functioning nodules [13]. Scintigraphy classify thyroid nodules as hot or cold according
to its iodine-trapping function, but this finding cannot differentiate between benign and malignant
nodule [14-16]. It was reported that incidence of malignancy detection by scintigraphy was only
17% [17]. Hot nodule may represent colloid goiter, chronic lymphocytic thyroiditis, adenomatous
goitre hyperplasia, follicular adenoma or rarely cancer [18]. Cold nodules are often benign with incidence of being malignant in range of 20-60% [19]. Also, thyroid
scintigraphy can be used to detect ectopic thyroid tissue in children
[20].
This study was conducted to describe clinical characteristics of
adolescent patients referred for thyroid scan during 5-years period in
Mansoura University Hospital.
Table 1
Methods
This retrospective study included all adolescent patients aged
from15-21years referred for thyroid scan during the period from
2010-2015 in nuclear medicine unit in Mansoura University Hospital.
Full history was taken from each patient including family history.
Both general and local examinations were performed. General
examination was aimed to looking for signs associated with thyroid
dysfunction while local one included examination of thyroid gland
and neck lymph nodes.
Thyroid scan was carried out through intravenous injection
of 3-5mCi of technetium-99 pertechnetate. Then 20 minutes post
injection; anterior and oblique views were acquired on a gamma
camera. The patient was placed in supine position and the neck
comfortably extended. Lead marks were used to identify anatomic
land marks as suprasternal notch. Location of any palpable nodules
must be confirmed using lead marker image for anatomic correlation.
Many features of thyroid scan can be found and final diagnosis
based on scanning features and laboratory results.
In the scan, when a nodule can be distinguished from surrounding
thyroid tissue; it was considered a solitary thyroid nodule. According
to functional status of a nodule, it was classified as functioning (hot)
and non- functioning (cold) according to amount of radioactivity in
it.
Simple multinodular goitre was considered if more than one
functioning and/or non- functioning nodules were detected in the
gland associated with normal thyroid laboratory tests. But if it was
associated with biochemical status of hyperthyroidism, we diagnosed
it as toxic multinodular goitre.
Hypothyroidism was diagnosed when free T4 (FT4) level was low
(<11.0 pmol/L) associated with increased TSH (>5.0mIU/L).While
hyperthyroidism was associated with high FT4 level (>22.0 pmol/L)
and low level of TSH (<0.1mIU/L).
Patient was diagnosed as simple goitre when he had diffusely
enlarged gland with normal thyroid function tests. But if diffusely
enlarged gland was associated with hyperthyroidism we suspected
Graves ‘disease.
Hashimoto’s disease was suspected when there was goitre with
hypothyroidism and high level of anti-thyroid antibodies as anti-perioxidase and anti-thyroglobulin antibodies.
When cancer was suspicious ultra-sound-guided biopsy was
taken.
Table 2
Results
This retrospective study included 60 adolescent patients referred
for thyroid scan, etiology of reference were: enlarged thyroid gland in
24 patients (40%), toxic symptoms in 17 patients (28.4%), abnormal
laboratory finding in 15 patients (25%),enlarged lymph node in 2
patients (3.3%) and absent thyroid in 2 patients (3.3%).
They were 46 (76.7%) females and 14 males (23.3%) with female
to male ratio of 3.3:1, as shown in Table 1.
Simple multinodular goitre was the most common finding
(46.7%) followed by graves' disease (25%) then Hashimoto' s disease
(11.7%). Patients with Hashimoto' s disease were diagnosed by diffuse
thyroid enlargement associated with hypothyroidism and elevated
level of antithyroid globulin and thyroid perioxidase antibodies.
Ectopic thyroid was reported in 2 female patients (3.3%) Solitary
thyroid nodule was found in 6 patients (10%) with toxic finding in
one case and simple in five.
Papillary thyroid carcinoma was diagnosed in 2 female patients
(3.3%) (Table 2).
Discussion
Enlargement of thyroid gland can be detected during routine
physical examination or observed by the patients themselves or
discovered during imaging of the neck incidently [21]. But the patient
can presented by clinical symptoms of: 1) hyperthyroidism such as
tachycardia, increased appetite with weight loss, increased sweating,
heat intolerance, exophthalmos and diarrhea. 2) Hypothyroidism
as bradycardia, decreased appetite with weight gain, tremors and
constipation [22]. 3) Compression as hoarsness of voice, dysphagia
and shortness of breath [23].
Incidence of thyroid diseases in adolescent were reported to be
more frequent in female than male with a ratio of 3:1 or more [24-26].
In our study it was 3.3:1.This can be contributed to increased levels of
sex hormones during puberty in females [27].
About 1 in 600.000 live births presented with lingual thyroid
during adolescence or childhood [28]. Lingual thyroid is diagnosed
when thyroid gland fails to descend to its normal position in the
neck. In 90% of cases the gland found within the tongue while 10%
in the anterior neck above the hyoid bone [29].This anomaly is more
prevelant in female. In our series, lingual thyroid was diagnosed in
3.3% of cases and they were female.
Graves ‘disease is the most common etiology of thyrotoxicosis in
children and adolescence [30,31].The cause of this disease is possibly the presence of autoantibodies against TSH receptors that stimulate
thyroid follicles to increase iodine uptake and cyclic adenosine
monophosphate production causing enlargement of the gland and
increase production of thyroid hormones. Studies supposed that
bacterial infection may induce the production of these antibodies
which react with TSH receptors [32]. In our series, graves' disease was
reported in 25% of cases.
When focal nodular hyperplasia occurs, it causes nodular
formation in the gland; some of these nodules have the ability to
secrete thyroxin and others become inactive. Fibrous septae result
from necrosis and scarring lead to multinodular goitre [33]. Simple
multinodular goitre was reported in about 47% of our patients;
comparable to that found by Rallison ML et al. [34]. Although solitary
thyroid nodule is common in general population; it is less common
in adolescent and children [35]. A solitary nodule may represent an
area of functional hyperplasia (adenoma) that may be associated
with secondary hyperthyroidism .Six cases of our patients (10%)
presented with solitary nodule with toxic finding in one case only.
In the United States, thyroid carcinoma is the second most common
cancer in females aged 15-19years [36]. Papillary thyroid carcinoma
is the most common cancer in adolescent [37]. It was diagnosed in 2
cases of our series. Hashimoto's thyroiditis was found in 7 patients
(11.7%). Hashimoto's thyroiditis was reported to be uncommon in
adolescent [38].
Conclusion
These study is retrospective with relatively small number of patients; so this preliminary results need to be confirmed through a prospective study with larger number of patients.
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