Aggiornamento
Le patologie della tiroide nell’infanzia e nell’adolescenza
Thyroid disorders in childhood and adolescence
Francesco Chiarelli1, Sergio Agostinelli2
1Professore e Presidente della Societŕ Europea di Endocrinologia Pediatrica, 2Scuola di Specializzazione in Pediatria,
Clinica Pediatrica, Universitŕ di Chieti
Marzo 2012 - pagg. 157 -167
Abstract
Thyroid diseases are the most common endocrinopathies in childhood and adolescence.
Congenital hypothyroidism affects infants from birth. The neurocognitive outcome of
these patients has been much improved with the newborn screening programmes. Autoimmune
thyroiditis is characterized by a wide spectrum of thyroid dysfunctions, ranging
from euthyroidism to overt hypothyroidism, with a variable clinical course in childhood.
Graves’ disease is the most common cause of paediatric hyperthyroidism. To
date, its optimal treatment remains a matter of debate. Thyroid nodules in childhood
and adolescence are rare, but they are more often malignant compared with those observed
in adulthood.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
1. Fisher DA. Second International Conference
on Neonatal Thyroid Screening: pro-gress report.
J Pediatr 1983;102:653-4.
2. Rastogi MV, LaFranchi SH. Congenital hypothyroidism.
Orphanet J Rare Dis 2010;5:17.
3. Olivieri A; The Study Group for Congenital Hypothyroidism.
The Italian National Register of infants
with congenital hypothyroidism: twenty
years of surveillance and study of congenital hypothyroidism.
Riv Ital Pediatr 2009;35:2.
4. Harris KB, Pass KA. Increase in congenital hypothyroidism
in New York State and in the United
States. Mol Genet Metab 2007;91:268-77.
5. Skordis N, Toumba M, Savva SC, et al. High
prevalence of congenital hypothyroidism in the
Greek Cypriot population: results of the neonatal
screening program 1990-2000. J Pediatr Endocrinol
2005;18:453-61.
6. Olney RS, Grosse SD, Vogt RF Jr. Prevalence of
congenital hypothyroidism - current trends and
future directions: workshop summary. Pediatrics
2010;125:S31-6.
7. Brown RS, Demmer LA. The etiology of thyroid
dysgenesis-still an enigma after all these
years. J Clin Endocrinol Metab 2002,87:4069-71.
8. Parks JS, Lin M, Grosse SD, et al. The impact of
transient hypothyroidism on the increasing rate
of congenital hypothyroidism in the United
States. Pediatrics 2010;125:S54-63.
9. Grant DB, Smith I, Fuggle PW, Tokar S, Chapple
J. Congenital hypothyroidism detected by
neonatal screening: relationship between biochemical
severity and early clinical features.
Arch Dis Child 1992;67:87-90.
10. American Academy of Pediatrics, Rose SR;
Section on Endocrinology and Committee on Genetics,
American Thyroid Association, Brown RS;
Public Health Committee, Lawson Wilkins Pediatric
Endocrine Society, Foley T, Kaplowitz PB,
Kaye CI, Sundararajan S, Varma SK. Update of
newborn screening and therapy for congenital
hypothyroidism. Pediatrics 2006;117:2290-303.
11. Revised guidelines for neonatal screening
programmes for primary congenital hypothyroidism.
Working Group on Neonatal Screening
of the European Society for Paediatric Endocrinology.
Horm Res 1999;52:49-52.
12. Ohnishi H, Sato H, Noda H, Inomata H, Sasaki
N. Color Doppler ultrasonography: diagnosis
of ectopic thyroid gland in patients with congenital
hypothyroidism caused by thyroid dysgenesis.
J Clin Endocrinol Metab 2003;88:5145-9.
13. Beltrăo CB, Juliano AG, Chammas MC,
Watanabe T, Sapienza MT, Marui S. Etiology of
congenital hypothyroidism using thyroglobulin
and ultrasound combination. Endocr J 2010;57:
587-93.
14. Fisher DA. The importance of early management
in optimizing IQ in infants with congenital
hypothyroidism. J Pediatr 2000;136: 273-4.
15. Rovet JF. In search of the optimal therapy for
congenital hypothyroidism. J Pediatr 2004;144:
698-700.
16. Bongers-Schokking JJ, Koot HM, Wiersma D,
Verkerk PH, de Muinck Keizer-Schrama SM. Influence
of timing and dose of thyroid hormone replacement
on development in infants with congenital
hypothyroidism. J Pediatr 2000;136:292-7.
17. Song SI, Daneman D, Rovet J. The influence
of etiology and treatment factors on intellectual
outcome in congenital hypothyroidism. J Dev Behav
Pediatr 2001;22:376-84.
18. Boileau P, Bain P, Rives S, Toublanc JE. Earlier
onset of treatment or increment in LT4 dose in
screened congenital hypothyroidism: which as
the more important factor for IQ at 7 years?
Horm Res 2004;61:228-33.
19. LaFranchi SH, Austin J. How should we be
treating children with congenital hypothyroidism?
J Pediatr Endocrinol 2007;20:559-78.
20. Dimitropoulos A, Molinari L, Etter K, et al.
Children with congenital hypothyroidism: longterm
intellectual outcome after early high-dose
treatment. Pediatr Res 2009;65:242-8.
21. Selva KA, Mandel SH, Rien L, et al. Initial
treatment dose of L-thyroxine in congenital hypothyroidism.
J Pediatr. 2002;141:786-92.
22. Salerno M, Militerni R, Bravaccio C, et al. Effect
of different starting doses of levothyroxine
on growth and intellectual outcome at four years
of age in congenital hypothyroidism. Thyroid
2002;12:45-52.
23. Bakker B, Kempers MJ, De Vijlder JJ, et al.
Dynamics of the plasma concentrations of TSH,
FT4 and T3 following thyroxine supplementation
in congenital hypothyroidism. Clin Endocrinol
(Oxf) 2002;57:529-37.
24. Selva KA, Harper A, Downs A, Blasco PA, La
Franchi SH. Neurodevelopmental outcomes in
congenital hypothyroidism: comparison of initial
T4 dose and time to reach target T4 and TSH. J
Pediatr 2005;147:775-80.
25. Oerbeck B, Sundet K, Kase BF, Heyerdahl S.
Congenital hypothyroidism: influence of disease
severity and L-thyroxine treatment on intellectual
motor, and school-associated outcomes in
young adults. Pediatrics 2003;112:923-30.
26. Dubuis JM, Glorieux J, Richer F, et al. Outcome
of severe congenital hypothyroidism: closing
the developmental gap with early high dose
levothyroxine replacement. J Clin Endocrinol
Metab 1996;81:222-7.
27. Heyerdahl S, Kase BF, Lie SO. Intellectual development
in children with congenital hypothyroidism
in relation to recommended thyroxine
treatment. J Pediatr 1991;118:850-7.
28. Dickerman Z, De Vries L. Prepubertal and pubertal
growth, timing and duration of puberty
and attained adult height in patients with congenital
hypothyroidism (CH) detected by the
neonatal screening program for CH: A longitudinal
study. Clin Endocrinol 1997;47:649-54.
29. Jones JH, Gellen G, Paterson WF, Beaton S,
Donaldson MD. Effect of high versus low initial
doses of L-thyroxine for congenital hypothyroidism
on thyroid function and somatic growth.
Arch Dis Child 2008;93:940-4.
30. Rovet JF, Ehrlich RM. Long term effects of Lthyroxine
therapy for congenital hypothyroidism.
J Pediatr 1995;126:380-6.
31. Rovet J, Alvarez M. Thyroid hormone and attention
in congenital hypothyroidism. J Pediatr
Endocrinol 1996;9:63-6.
32. Heyerdahl S. Treatment variables as predictors
of intellectual outcome in children with congenital
hypothyroidism. Eur J Pediatr 1996;155:
357-61.
33. Heyerdahl S, Oerbeck B. Congenital hypothyroidism:
developmental outcome in relation
to levothyroxine treatment variables. Thyroid
2003;13:1029-38.
34. Hashimoto H. Zur Kenntiss der lymphomatosen
Ver-anderung der Schilddruse (Struma
Lymphomatosa). Arch Klin Chir 1912;97:219-48.
35. Gribetz D, Talbot NB, Crawford JD. Goitre
due to lymphocytic thyroiditis (Hashimoto’s struma);
its occurrence in preadolescent and adolescent
girls. N Engl J Med 1954;250:555-7.
36. Rallison ML, Dobyns BM, Keating FR, Rall
JE, Tyler FH. Occurrence and natural history of
chronic lymphocytic thyroiditis in childhood. J
Pediatr 1975;86:675-82.
37. Rallison ML, Dobyns BM, Meikle AW, Bishop
M, Lyon JL, Stevens W. Natural history of thyroid
abnormalities: prevalence, incidence, and regression
of thyroid diseases in adolescents and
young adults. Am J Med 1991;91:363-70.
38. Gopalakrishnan S, Marwaha RK. Juvenile autoimmune
thyroiditis. J Pediatr Endocrinol
Metab 2007;20:961-70.
39. Radetti G, Gottardi E, Bona G, et al.; Study
Group for Thyroid Diseases of the Italian Society
for Pediatric Endocrinology and Diabetes
(SIEDP/ISPED). The natural history of euthyroid
Hashimoto’s thyroiditis in children. J Pediatr
2006;149:827-32.
40. Desai MP, Karandikar S. Autoimmune thyroid
disease in childhood: a study of children and
their families. Ind Pediatr 1999;36:59-68.
41. Marwaha RK, Sen S, Tandon N, et al. Familial
aggregation of autoimmune thyroiditis in first-degree
relatives of patients with juvenile autoimmune
thyroid disease. Thyroid 2003;13:299-302.
42. Larizza D, Calcaterra V, De Giacomo C, et al.
Celiac disease in children with autoimmune thyroid
disease. J Pediatr 2001;139:738-40.
43. Kordonouri O, Klinghammer A, Lang EB,
Gruters-Kieslich A, Grabert M, Holl RW. Thyroid
Le patologie della tiroide nell’infanzia e nell’adolescenza
165
MESSAGGI CHIAVE
o In Italia, la prevalenza dell’ipotiroidismo
congenito č di 1/2400, valore
corrispondente a quello medio delle
popolazioni occidentali. A questi vanno
aggiunti i casi, molto piů rari, da
difetto specifico dell’ormonogenesi. Il
trattamento č concettualmente semplice
(L-tiroxina per tutta la vita).
o La precocitŕ del trattamento (15-30
giorni) e la partenza con dosi elevate
di L-tiroxina (in media 37,5 microgrammi/
die) rappresentano i due punti
essenziali per l’effetto sul SNC (16
punti di QI in piů rispetto a quelli trattati
piů tardivamente).
o La tiroidite autoimmune č la patologia
tiroidea piů frequente (1,2%), molto
piů comune nelle femmine, nella celiachia,
nella sindrome di Turner. Č una
malattia autoanticorpale e la diagnosi
di certezza č legata al dosaggio degli
autoanticorpi. La sua evoluzione tipica
č in ipotiroidismo. La diagnosi di
probabilitŕ č clinica (ingrossamento
della ghiandola) e basata sul dosaggio
degli ormoni tiroidei.
o Anche la malattia di Graves č una tiroidite
autoimmune, da autoanticorpi
che legano e stimolano il recettore per
TSH con un quadro clinico e di laboratorio
di ipertiroidismo.
o I noduli tiroidei, a tutte le etŕ, possono
essere tumorali (adenomi o carcinomi),
oppure espressione di tiroidite,
o effetto di una povertŕ di iodio. La
diagnosi passa attraverso l’ecografia
color-doppler e, su indicazione di questa,
attraverso l’agopuntura e la biopsia.
Medico e Bambino 3/2012
autoimmunity in children and adolescents with
type 1 diabetes: a multicenter survey. Diabetes
Care 2002;25:1346-50.
44. Laurberg P. Iodine intake - What are we aiming
at? J Clin Endocrinol Metab 1994;79:17-9.
45. Zois C, Stavrou I, Kalogera C, et al. High
prevalence of auto-immune thyroiditis in schoolchildren
after elimination of iodine deficiency in
Northwestern Greece. Thyroid 2003;13:485-9.
46. De Groot LJ, Quintans J. The causes of autoimmune
thyroid disease. Endocr Rev 1989;10:
537-62.
47. Kanga U, Tandon N, Marwaha RK, et al. Immunogenetic
association and thyroid autoantibodies
in JAT in North India. Clin Endocrinol
(Oxf) 2006;64:573-9.
48. Segnil M, Pani MA, Pasquino AM, Badenhoop
K. Familial clustering of juvenile thyroid autoimmunity:
higher risk is conferred by human
leukocyte antigen DR3-DQ2 and thyroid peroxidase
antibody status in fathers. J Clin Endocrinol
Metab 2002;75:943-6.
49. Phillips DI, Cooper C, Fall C, et al. Fetal
growth and autoimmune thyroid disease. Q J
Med 1993;86:247-53.
50. Mäenpää J, Raatikka M, Räsänen J, Taskinen
E, Wager O. Natural course of juvenile autoimmune
thyroiditis. J Pediatr 1985;107:898-904.
51. Zois C, Stavrou I, Svarna E, Seferiadis K, Tsatsoulis
A. Natural course of autoimmune thyroiditis
after elimination of iodine deficiency in northwestern
Greece. Thyroid 2006;16:289-93.
52. Kaplowitz PB. Subclinical hypothyroidism in
children: normal variation or sign of a failing thyroid
gland? Int J Pediatr Endocrinol 2010;2010:
281453.
53. Nabhan ZM, Kreher NC, Eugster EA. Hashitoxicosis
in children: clinical features and natural
history. J Pediatr 2005;146:533-6.
54. Jaruratanasirikul S, Leethanaporn K, Khuntigij
P, Sriplung H. The clinical course of Hashimoto’s
thyroiditis in children and adolescents: 6
years longitudinal follow-up. J Pediatr Endocrinol
Metab 2001;14:177-84.
55. Sklar CA, Qazi R, David R. Juvenile autoimmune
thyroiditis. Hormonal status at presentation
and after long-term follow-up. Am J Dis Child
1986;140:877-80.
56. Moore DC. Natural course of ‘subclinical’ hypothyroidism
in childhood and adolescence.
Arch Pediatr Adolesc Med 1996;150:293-7.
57. Gopalakrishnan S, Chugh PK, Chhillar M, et
al. Goitrous autoimmune thyroiditis in a pediatric
population: a longitudinal study. Pediatrics 2008;
122:e670-4.
58. Fava A, Oliverio R, Giuliano S, et al. Clinical
evolution of autoimmune thyroiditis in children
and adolescents. Thyroid 2009;19:361-7.
59. Demirbilek H, Kandemir N, Gonc EN, Ozon
A, Alikasifoglu A. Assessment of thyroid function
during the long course of Hashimoto’s thyroiditis
in children and adolescents. Clin Endocrinol
(Oxf) 2009;71:451-4.
60. Wang SY, Tung YC, Tsai WY, Lee JS, Hsiao
PH. Long-term outcome of hormonal status in
Taiwanese children with Hashimoto’s thyroiditis.
Eur J Pediatr 2006;165:481-3.
61. Corrias A, Cassio A, Weber G, et al.; Study
Group for Thyroid Diseases of the Italian Society
for Pediatric Endocrinology and Diabetology
(SIEDP/ISPED). Thyroid nodules and cancer in
children and adolescents affected by autoimmune
thyroiditis. Arch Pediatr Adolesc Med
2008;162:526-31.
62. Watemberg N, Greenstein D, Levine AJ. Encephalopathy
associated with Hashimoto thyroiditis:
pediatric perspective. J Child Neurol
2006;21:1-5.
63. Bachrach LK, Foley TP Jr. Thyroiditis in children.
Pediatr Rev 1989;11:184-91.
64. Zen VL, Czepielewski MA, de Paula LP, Schwerz
JC. Subclinical hypothyroidism prevalence in
children evaluated for short stature. In: Proceedings
of the 91st Annual Meeting of the Endocrine
Society. Washington, DC, USA, June 2009.
65. Zen VL, Czepielewski MA, de Paula LP, Schwerz
JC. Thyroxin replacement therapy does not
improve growth velocity in children with subclinical
hypothyroidism and short stature. In:
Proceedings of the 91st Annual Meeting of the
Endocrine Society. Washington, DC, USA, June
2009.
66. Surks MI, Ortiz E, Daniels GH, et al. Subclinical
thyroid disease: scientific review and guidelines
for diagnosis and management. JAMA 2004;
291:228-38.
67. Gharib H, Tuttle RM, Baskin HJ, Fish LH,
Singer PA, McDermott MT. Consensus statement:
subclinical thyroid dysfunction: a joint
statement on management from the American
Association of Clinical Endocrinologists, the
American Thyroid Association and the Endocrine
Society. J Clin Endocrinol Metab 2005;90:
581-5.
68. Kabelitz M, Liesenkötter KP, Stach B, et al.
The prevalence of anti-thyroid peroxidase antibodies
and autoimmune thyroiditis in children
and adolescents in an iodine replete area. Eur J
Endocrinol 2003;148:301-7.
69. Scarpa V, Kousta E, Tertipi A, et al. Treatment
with thyroxine reduces thyroid volume in euthyroid
children and adolescents with chronic autoimmune
thyroiditis. Horm Res Paediatr 2010;
73:61-7.
70. Karges B, Muche R, Knerr I, et al. Levothyroxine
in euthyroid autoimmune thyroiditis and
type 1 diabetes: a randomized, controlled trial. J
Clin Endocrinol Metab 2007;92:1647-52.
71. Svensson J, Ericsson UB, Nilsson P, et al.
Levothyroxine treatment reduces thyroid size in
children and adolescents with chronic autoimmune
thyroiditis. J Clin Endocrinol Metab 2006;
91:1729-34.
72. Lavard L, Ranlov I, Perrild H, Andersen O, Jacobsen
BB. Incidence of juvenile thyrotoxicosis
in Denmark, 1982-1988. A nationwide study. Eur
J Endocrinol 1994;130:565-8.
73. Kaguelidou F, Carel JC, Léger J. Graves’ disease
in childhood: advances in management with
antithyroid drug therapy. Horm Res 2009;71:310-7.
74. Wong GW, Cheng PS. Increasing incidence of
childhood Graves’ disease in Hong Kong: a followup
study. Clin Endocrinol (Oxf) 2001;54:547-50.
75. Yang F, Shan Z, Teng X, et al. Chronic iodine
excess does not increase the incidence of hyperthyroidism:
a prospective community-based epidemiological
survey in China. Eur J Endocrinol
2007;156:403-8.
76. Zimmerman D, Gan-Gaisano M. Hyperthyroidism
in children and adolescents. Pediatr Clin
North Am 1990;37:1273-95.
77. Cooper DS. Hyperthyroidism. Lancet 2003;
362:459-68.
78. Saitoh O, Nagayama Y. Regulation of Graves’
hyperthyroidism with naturally occurring
CD4+CD25+ regulatory T cells in a mouse model.
Endocrinology 2006;147:2417-22.
79. Brix TH, Kyvik KO, Hegedus L. What is the
evidence of genetic factors in the etiology of
Graves’ disease? A brief review. Thyroid 1998;8:
727-34.
80. Brix TH, Kyvik KO, Christensen K, Hegedus
L. Evidence for a major role of heredity in Graves’
disease: a population-based study of two Danish
twin cohorts. J Clin Endocrinol Metab 2001;86:
930-4.
81. Birrell G, Cheetham T. Juvenile thyrotoxicosis;
can we do better? Arch Dis Child 2004;89:745-50.
82. Kahaly GJ. Imaging in thyroid-associated orbitopathy.
Eur J Endocrinol 2001;145:107-18.
83. Lucidarme N, Ruiz JC, Czernichow P, Leger J.
Reduced bone mineral density at diagnosis and
bone mineral recovery during treatment in children
with Graves’ disease. J Pediatr 2000;137:56-62.
84. Kaguelidou F, Alberti C, Castanet M, Guitteny
MA, Czernichow P, Leger J. Predictors of autoimmune
hyperthyroidism relapse in children
after discontinuation of antithyroid drug treatment.
J Clin Endocrinol Metab 2008;93: 3817-26.
85. Cooper DS. Antithyroid drugs. N Engl J Med
2005;352:905-17.
86. Nakamura H, Noh JY, Itoh K, Fukata S,
Miyauchi A, Hamada N. Comparison of methimazole
and propylthiouracil in patients with hyperthyroidism
caused by Graves’ disease. J Clin
Endocrinol Metab 2007;92:2157-62.
87. Rivkees SA, Szarfman A. Dissimilar hepatotoxicity
profiles of propylthiouracil and methimazole
in children. J Clin Endocrinol Metab
2010;95:3260-7.
88. Rivkees SA. Pediatric Graves’ disease: controversies
in management. Horm Res Paediatr
2010;74:305-11.
89. Rivkees SA, Stephenson K, Dinauer C. Adverse
events associated with methimazole therapy
of Graves’ disease in children. Int J Pediatr Endocrinol
2010;2010:176970.
90. Glaser NS, Styne DM. Predicting the likelihood
of remission in children with Graves’ disease:
a prospective, multicenter study. Pediatrics
2008;121:e481-8.
91. Shulman DI, Muhar I, Jorgensen EV, Diamond
FB, Bercu BB, Root AW. Autoimmune hyperthyroidism
in prepubertal children and adolescents:
comparison of clinical and biochemical
features at diagnosis and responses to medical
therapy. Thyroid 1997;7:755-60.
92. Hamburger JI. Management of hyperthyroidism
in children and adolescents. J Clin Endocrinol
Metab 1985;60:1019-24.
93. Glaser NS, Styne DM. Predictors of early remission
of hyperthyroidism in children. J Clin
Endocrinol Metab 1997;82:1719-26.
94. Gruneiro-Papendieck L, Chiesa A, Finkielstain
G, Heinrich JJ. Pediatric Graves’ disease:
outcome and treatment. J Pediatr Endocrinol
Metab 2003;16:1249-55.
95. Lazar L, Kalter-Leibovici O, Pertzelan A,
Weintrob N, Josefsberg Z, Phillip M. Thyrotoxicosis
in prepubertal children compared with pubertal
and postpubertal patients. J Clin Endocrinol
Metab 2000;85:3678-82.
96. Smith J, Brown RS. Persistence of thyrotropin
receptor antibodies in children and adolescents
with Graves’ disease treated using antithyroid
medication. Thyroid 2007;17:1103-7.
97. Wang SH, Baker JR Jr. Targeting B cells in
Graves’ disease. Endocrinology 2006;147:4559-60.
98. El Fassi D, Nielsen CH, Hasselbalch HC,
Hegedus L. The rationale for B lymphocyte depletion
in Graves’ disease. Monoclonal anti-CD20
antibody therapy as a novel treatment option. Eur
J Endocrinol 2006;154:623-32.
99. El Fassi D, Nielsen CH, Bonnema SJ, Hasselbalch
HC, Hegedus L. B lymphocyte depletion
with the monoclonal antibody rituximab in
Graves’ disease: a controlled pilot study. J Clin
Endocrinol Metab 2007;92:1769-72.
100. Chao M, Jiawei X, Guoming W, et al. Radioiodine
treatment for pediatric hyperthyroid
Grave’s disease. Eur J Pediatr 2009;168:1165-9.
101. Rivkees SA, Dinauer C. An optimal treatment
for pediatric Graves’ disease is radioiodine.
J Clin Endocrinol Metab 2007;92:797-800.
102. Lee JA, Grumbach MM, Clark OH. The optimal
treatment for pediatric Graves’ disease is
surgery. J Clin Endocrinol Metab 2007; 92:801-3.
166 Medico e Bambino 3/2012
Aggiornamento
103. Corrias A, Mussa A, Baronio F, et al; Study
Group for Thyroid Diseases of Italian Society for
Pediatric Endocrinology and Diabetology
(SIEDP/ISPED). Diagnostic features of thyroid
nodules in pediatrics. Arch Pediatr Adolesc Med
2010;164:714-9.
104. Niedziela M. Pathogenesis, diagnosis and
management of thyroid nodules in children. Endocr
Relat Cancer 2006;13:427-53.
105. Wiersinga WM. Management of thyroid
nodules in children and adolescents. Hormones
(Athens) 2007;6:194-9.
106. Dinauer CA, Breuer C, Rivkees SA. Differentiated
thyroid cancer in children: diagnosis and
management. Curr Opin Oncol 2008;20:59-65.
107. Dinauer C, Francis GL. Thyroid cancer in
children. Endocrinol Metab Clin North Am 2007;
36:779-806.
108. Hayles AB, Kennedy RL, Beahrs OH, Woolner
LB. Management of the child with thyroidal
carcinoma. JAMA 1960;173:21-8.
109. Gharib H, Papini E. Thyroid nodules: Clinical
importance, assessment, and treatment. Endocrinol
Metab Clin North Am 2007;36:707-35.
110. Hung W. Solitary thyroid nodules in 93 children
and adolescents, a 35-year experience.
Horm Res 1999;52:15-8.
111. Raab SS, Silverman JF, Elsheikh TM,
Thomas PA, Wakely PE. Pediatric thyroid nodules:
disease demographics and clinical management
as determined by fine needle aspiration
biopsy. Pediatrics 1995;95:46-9.
112. Koch CA, Sarlis NJ. The spectrum of thyroid
disease in childhood and its evolution during
transition to adulthood: natural history, diagnosis,
differential diagnosis and management. J Endocrinol
Invest 2001;24:659-75.
113. Wu XC, Chen VW, Steele B, et al. Cancer incidence
in adolescents and young adults in the
United Stated, 1992-1997. J Adolesc Health 2003;
32:405-15.
114. Hogan AR, Zhuge Y, Perez EA, et al. Pediatric
thyroid carcinoma: incidence and outcomes
in 1753 patients. J Surg Res 2009;156:167-72.
115. Tronko MD, Bodanova TI, Komissarenko
IV, et al. Thyroid carcinoma in children after the
Chernobyl nuclear accident: statistical data and
clinicomorphologic characteristics. Cancer 1999;
86:149-56.
116. Shafford EA, Kingston JE, Healy JC, Webb
JA, Plowman PN, Reznek RH. Thyroid nodular
disease after radiotherapy to the neck for childhood
Hodgkin’s disease. Br J Cancer 1999;80:
808-14.
117. Brandi ML, Gagel RF, Angeli A, et al. Guidelines
for diagnosis and therapy of MEN type 1 and
type 2. Clin Endocrinol Metab 2001;86:5658-71.
118. Malchoff CD, Malchoff DM. Familial nonmedullary
thyroid carcinoma. Semin Surg Oncol
1999;16:16-8.
119. Al-Shaikh A, Ngan BM, Daneman A, Daneman
D. Fine-needle aspiration biopsy in the management
of thyroid nodules in children and adolescents.
J Pediatr 2001;138:140-2.
120. Schwab KO, Pfarr N, van der Werf-
Grohmann N, et al. Autonomous thyroid adenoma:
only an adulthood diseas e? J Pediatr 2009;
154:931-3.e2.
121. Yamashita S, Saenko V. Mechanisms of disease:
molecular genetics of childhood thyroid
cancers. Nat Clin Pract Endocrinol Metab 2007;3:
422-9.
122. Szinnai G, Meier C, Komminoth P, Zumsteg
UW. Review of multiple endocrine neoplasia type
2A in children: therapeutic results of early thyroidectomy
and prognostic value of codon analysis.
Pediatrics 2003;111;e132-9.
123. Calkovsky V, Hajtman A. Thyroid diseases
in children and adolescents. Bratisl Lek Listy
2009;110:31-4.
124. Corrias A, Einaudi S, Chiorboli E, et al. Accuracy
of fine needle aspiration biopsy of thyroid
nodules in detecting malignancy in childhood:
comparison with conventional clinical, laboratory,
and imaging approaches. J Clin Endocrinol
Metab 2001;86:4644-8.
125. Papini E, Valcavi R, Baskin HJ, et al;
AACE/AME Task Force on Thyroid Nodules.
American Association of Clinical Endocrinologists
and Associazione Medici Endocrinologi.
Medical guidelines for clinical practice for the diagnosis
and management of thyroid nodules. Endocr
Pract 2006;12:63-102.
126. Jarzab B, Handkiewicz Junak D, et al. Multivariate
analysis of prognostic factors for differentiated
thyroid carcinoma in children. Eur J Nucl
Med 2000;27:833-41.
127. Skinner MA. Management of hereditary thyroid
cancer in children. Surg Oncol 2003:12:101-4.
Corrispondenza: sergio_agostinelli@yahoo.it
