Goiters and Nodules
Although goiters and nodules are more common in older adults, they can occur in children as well. Both are more common in girls than boys. And children get goiters and nodules for most of the same reasons that adults do, although multinodular goiter is rare in children. Kids are more likely to have diffuse goiters caused by autoimmune disease.
Like adults, children living in regions of the world deficient in iodine are prone to developing goiters. Inadequate iodine stimulates the release of TSH, which, in turn, causes the thyroid gland to become enlarged as it struggles to produce more thyroid hormone. Here in the United States, the most common cause for a goiter in children is Hashimoto's disease. In fact, a goiter may be the first and most obvious sign of the disorder that parents will notice. The neck may appear full or swollen, and the child may say she feels pressure in her neck or throat.
Children may also develop goiters as the result of thyroiditis, inflammation of the thyroid gland, or Graves' disease, which causes hyperthyroidism. In some cases, a child may develop a goiter but still have normal thyroid function, which is a euthyroid goiter.
Treatment for goiters in children involves treating the underlying disease. For instance, thyroid hormone replacement given for Hashimoto's usually causes the goiter to shrink. But if a goiter is euthyroid, small, and not causing any problems with breathing or swallowing, your doctor may do nothing and simply keep an eye on it.
Thyroid nodules are less common in children than in adults, but when they do occur, they're slightly more likely to be malignant than nodules in adults are. Close examination and testing of the nodule is critical to determine the cause of the nodule. Fortunately, the majority of nodules in kids will turn out to be benign.
Although rare, some older children may develop a toxic adenoma, nodules that produce their own supply of thyroid hormone as a result of faulty TSH receptor. When the amount of thyroid hormone becomes significantly elevated, your child will eventually experience symptoms of hyperthyroidism. An RAIU test and scan will reveal that the nodule is hot and absorbing iodine.
To the untrained eye (or hand), it's easy to mistake a swollen lymph node for a thyroid nodule. After all, both are on the neck. Swollen lymph nodes tend to occur when there is an infection and are located more on the sides of the neck. A thyroid nodule would be farther down, near the base of the neck. Always check with your doctor if you feel any lump.
In general, a small toxic adenoma is best treated with radioactive iodine, while a larger one may require surgery. Antithyroid drugs will have little effect since toxic adenomas do not go into remission.