Occult Thyroid Cancer in Autoimmune Thyroiditis: Lymph Node Ultrasound as the Sole Diagnostic Indicator of Malignancy in a Pediatric Case of Papillary Thyroid Carcinoma.
Maria Szwarkowska, Konrad Kaleta, Aleksandra Jurek, Monika Kujdowicz, Anna Taczanowska-Niemczuk, Aleksandra Kiszka-Wiłkojć, Marcin Maślanka, Wojciech Górecki, Jerzy Starzyk, Dominika Januś
Author Information
Maria Szwarkowska: Students' Scientific Group of Pediatric Auxology, Faculty of Medicine, Jagiellonian University Medical College, University Children's Hospital in Krakow, Wielicka 265, 30-663 Krakow, Poland.
Konrad Kaleta: Students' Scientific Group of Pediatric Auxology, Faculty of Medicine, Jagiellonian University Medical College, University Children's Hospital in Krakow, Wielicka 265, 30-663 Krakow, Poland. ORCID
Aleksandra Jurek: Students' Scientific Group of Pediatric Auxology, Faculty of Medicine, Jagiellonian University Medical College, University Children's Hospital in Krakow, Wielicka 265, 30-663 Krakow, Poland.
Monika Kujdowicz: Department of Pathomorphology, Jagiellonian University Medical College, 31-121 Krakow, Poland. ORCID
Anna Taczanowska-Niemczuk: Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University Medical College, 31-121 Krakow, Poland.
Aleksandra Kiszka-Wiłkojć: Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University Medical College, 31-121 Krakow, Poland.
Marcin Maślanka: Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University Medical College, 31-121 Krakow, Poland.
Wojciech Górecki: Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University Medical College, 31-121 Krakow, Poland.
Jerzy Starzyk: Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, 32-121 Krakow, Poland.
Dominika Januś: Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, 32-121 Krakow, Poland. ORCID
BACKGROUND: Autoimmune thyroiditis (AIT) is a common thyroid disorder in children, linked to an increased risk of papillary thyroid carcinoma (PTC). Characteristic ultrasonographic features of AIT can obscure PTC, delaying diagnosis. CASE PRESENTATION: An 11-year-old girl with a two-year history of AIT presented with persistently elevated thyroid-stimulating hormone (TSH) levels despite levothyroxine therapy. Examination revealed a firm, slightly enlarged right thyroid lobe. Serial thyroid ultrasounds showed typical AIT features, with no apparent tumor. However, a cervical lymph node ultrasound detected a suspicious lymph node with pathological vascularization. Fine-needle aspiration suggested possible PTC metastasis. The patient underwent total thyroidectomy with central and right lateral neck dissection. Histopathology confirmed multifocal PTC with cervical lymph node metastases (pT3aN1bM0). Postoperative radioactive iodine therapy resulted in undetectable thyroglobulin levels, indicating a biochemical response. CONCLUSIONS: Children with AIT may harbor occult PTC even without thyroid gland abnormalities suggestive of malignancy. Comprehensive ultrasound evaluation, including cervical lymph nodes, is vital for early detection and timely treatment.
