Causes of acquired goiter in children and adolescents

Disorder	TSH	TPO or Tg antibodies	TSH receptor antibodies*	Imaging
Usually euthyroid
Chronic autoimmune (Hashimoto) thyroiditis	Normal or ↑ (occasionally ↓)	+ ^¶	– ^Δ	US – Scattered hypo- or hyperechogenicity ("moth-eaten") I-123 scan (if performed) Euthyroid – Uptake usually normal Hypothyroid (↑ TSH) – Uptake increased Hyperthyroid phase (↓ TSH) – Uptake nil
Colloid goiter	Normal	–	–	US – Colloid cysts
Thyroid neoplasm (benign adenoma, carcinoma)	Normal	–	–	US – Nodules If large (>1 cm), these may be confused with a goiter; smaller nodules may present with a goiter of other etiology (eg, autoimmune thyroiditis)
Acute suppurative thyroiditis	Normal or ↓	–	–	I-123 scan (if performed) – Uptake reduced or nil if patient is in a hyperthyroid phase (↓ TSH) Esophagram, CT, or MRI – Pyriform sinus fistula
Usually hypothyroid
Excess iodine ingestion (eg, (in health food supplements or drugs, eg, amiodarone)	↑	–	–	US – Normal or small goiter I-123 scan (if performed) – Uptake reduced
Ingestion of other goitrogens or drugs (eg, tyrosine kinase inhibitors, checkpoint inhibitors)	↑	–	–	US – Normal or small goiter I-123 scan (if performed) – Uptake normal or reduced
Iodine deficiency	↑	–	–	US – Normal or small goiter I-123 scan (if performed) – Uptake increased
Thyroid infiltrative disease (histiocytosis, cystinosis)	↑	–	–	US – Normal or small goiter
Subacute granulomatous thyroiditis (de Quervain disease); late	↑	–	–	US – Normal or small goiter, heterogeneous pattern I-123 scan (if performed) – Uptake normal or increased during recovery phase, when TSH is ↑
Usually hyperthyroid
Graves disease	↓	+/–	+	US – Diffuse hyperplasia I-123 scan (if performed) – Elevated or normal uptake at 4 and 24 hours
Autonomous ("hot") nodule	↓	–	–	US – Discrete nodule I-123 scan – Increased uptake within the nodule; decreased or absent uptake in the remainder of the gland
Toxic multinodular goiter	↓	–	–	US – Multiple nodules I-123 scan – Discrete areas of increased uptake throughout the gland
Subacute granulomatous thyroiditis (de Quervain disease); early	↓	–	–	I-123 scan – Uptake reduced or nil during hyperthyroid phase, when TSH is ↓

TSH: thyroid-stimulating hormone; TPO: antithyroid peroxidase; Tg: antithyroglobulin; US: thyroid ultrasound; I-123: radionucleotide uptake and scan with iodine 123; CT: computed tomography; MRI: magnetic resonance imaging; TBII: thyrotropin-binding inhibitory immunoglobulins; TSI: thyroid-stimulating immunoglobulins.
* TSH receptor antibodies (abbreviated either TRAb or TSHR-Ab) may be TBII if hypothyroidism suspected or TSI if hyperthyroidism suspected.
¶ Among pediatric patients with chronic autoimmune thyroiditis, 10 to 15% have negative antithyroid antibodies (TPO and Tg); this is known as "antibody-negative" chronic autoimmune thyroiditis.
Δ Hypothyroidism associated with chronic autoimmune (Hashimoto) thyroiditis may be caused by a TSH receptor-blocking antibody, most commonly measured as TBII.

Graphic 77604 Version 3.0

خرید پکیج

Causes of acquired goiter in children and adolescents