Autoimmune thyroiditis increases cancer risk for children with thyroid nodules
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Among children with thyroid nodules, those with autoimmune thyroiditis have a higher risk for developing thyroid cancer compared with those without autoimmune thyroiditis, according to a study published in Thyroid.
“The presence of autoimmune thyroiditis was associated with an increased risk of thyroid cancer, but not with thyroid cancer stage at diagnosis,” Ari J. Wassner, MD, medical director of the Thyroid Center and director of the fellowship program in the division of endocrinology at Boston Children’s Hospital and assistant professor of pediatrics at Harvard Medical School, and colleagues wrote. “A clinical diagnosis of autoimmune thyroiditis based on the presence of thyroid autoantibodies or diffusely heterogeneous thyroid echotexture may inform the assessment of thyroid cancer risk and surgical decision-making in children with thyroid nodules.”
Researchers conducted a retrospective review of children and adolescents aged 18 years and younger who underwent fine-needle aspiration of a thyroid nodule 1 cm in diameter or larger between 1998 and 2020 at Boston Children’s Hospital and Brigham and Women’s Hospital. Demographics and clinical characteristics were obtained from medical records, and the cytology of each nodule was recorded. Clinical autoimmune thyroiditis was defined by the presence of autoantibodies to thyroperoxidase or thyroglobulin, or diffusely heterogeneous thyroid echotexture. Aggregate autoimmune thyroiditis was defined by the presence of clinical autoimmune thyroiditis or findings of diffuse lymphocytic thyroiditis on surgical histopathology.
The presence of thyroid cancer was determined through histopathology for resected nodules.
There were 458 nodules in 385 participants included in the analysis (median age, 15.5 years; 81% female). Malignancy was observed in 27% of patients, 25% had clinical autoimmune thyroiditis, and 28% had aggregate autoimmune thyroiditis.
In multivariable analysis, children and adolescents were more likely to have thyroid cancer if they had clinical autoimmune thyroiditis (OR = 2.4; 95% CI, 1.42-4.03; P = .001) and a larger nodule diameter (OR = 1.05; 95% CI, 1.03-1.07; P < .001). Girls had lower odds for thyroid cancer than boys (OR = 0.53; 95% CI, 0.29-0.92; P = .02), and those with multiple nodules had a lower risk for thyroid cancer than those with one nodule (OR = 0.48; 95% CI, 0.27-0.85; P = .01).
In subject-level analysis, the presence of clinical autoimmune thyroiditis (OR = 2.19; 95% CI, 1.32-3.62; P = .002) and aggregate autoimmune thyroiditis (OR = 3.79; 95% CI, 2.3-6.24; P < .001) were associated with an increased risk for thyroid cancer. Younger age was also associated with a greater likelihood for thyroid cancer (OR = 0.92; 95% CI, 0.84-0.99; P = .03).
“The presence of clinical autoimmune thyroiditis was associated with a twofold increase in cancer risk, which suggests that evaluating thyroid autoantibodies and thyroid echotexture during thyroid nodule evaluation in children may provide useful information to guide cancer risk assessment and surgical decision-making,” the researchers wrote.
Among youths with papillary thyroid carcinoma, those with the diffuse sclerosing variant were more likely to have clinical autoimmune thyroiditis than those with the classical variant (OR = 4.74; 95% CI, 1.33-16.9; P = .02) or the follicular variant (OR = 15; 95% CI, 2.8-80.4; P = .002), they wrote.
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