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Long-term ultrasound follow-up of intrathyroidal ectopic thymus in children

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Abstract

Objective

To present the sonographic follow-up of intrathyroidal ectopic thymus (IET) in children and adolescent patients.

Patients

Out of the 507 children referred to FNAB between 2006 and 2018, 30 (5.9%) pediatric patients (10 females), mean age 5.7 years (1.2–13.8, median 4.9 years) were diagnosed with IET.

Methods

A retrospective analysis of medical files of patients diagnosed with IET between 2006 and 2018. Assessed data included ultrasound characterisation, elastographic strain ratio (SR) results and hormonal evaluation.

Results

Analysis of thyroid US scans revealed that the mean age at the first thyroid ultrasound was 5.7 (1.2–13.8, median 4.9) years, and at the last US 10.7 (3.7–18, median 10.5) years. The mean time of the IET observation was 59.6 (2–148, median 53.5) months. On US, IET was hypoechoic with multiple linear and punctate echoes, hypovascular, fusiform on longitudinal plane and round or polygonal on an axial plane, more common in the right thyroid lobe (66.7%) and located in the posterior part of the lobes (54.5%), bilateral in two patients and multifocal in one patient. SR of IET was similar to the surrounding normal thyroid tissue. Complete regression of IET was observed in 12/30 patients after a mean time of 81.7 months (median 76.5), at the mean age of 13.7 (9.2–18, median 13.9) years. FNAB was performed in 10/30 and a hemithyroidectomy in 1/30 IET patients. In the FNAB (+) group, patients were younger (5.08 vs 6.08 years) and lesions were larger (0.12 ml vs 0.05 ml) than in the FNAB (−) group. All patients with IET were euthyroid with negative TPOAb and TgAb levels.

Conclusion

The reproducibility of unique ultrasound features of IETs allows for safe long-term follow-up of these benign lesions in the majority of pediatric patients: not only monitoring the regression of IET but also screening towards the rare occurrence of a tumor arising from the IET.

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Acknowledgements

Łukasz Wyrobek, MD, PhD (Department of Pediatric Radiology, University Children’s Hospital, Krakow, Poland).

Funding

This study has not received any funding.

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Authors and Affiliations

  1. Department of Paediatric and Adolescent Endocrinology, Chair of Paediatrics, Institute of Paediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Kraków, Poland

    D. Januś, A. Kalicka-Kasperczyk, M. Wójcik & J. B. Starzyk

  2. Department of Paediatric and Adolescent Endocrinology, University Children’s Hospital, Kraków, Poland

    D. Januś, A. Kalicka-Kasperczyk, M. Wójcik & J. B. Starzyk

  3. Department of Clinical Immunology and Transplantation, Institute of Paediatrics, Jagiellonian University Medical College, Kraków, Poland

    G. Drabik

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Contributions

Study design: DJ, AKK. Study conduct: DJ, AKK. Data collection: DJ, MW, AKK, GD. Data analysis: DJ, AKK, MW. Data interpretation: DJ, MW, AKK. Drafting manuscript: DJ. Revising manuscript content: DJ, MW, and JS. Approving final version of manuscript: DJ, AKK, MW, and JS. DJ takes responsibility for the integrity of the data analysis.

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Correspondence to D. Januś.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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This study was retrospective and involved patients medical files and did not involve human or animal participants.

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Informed consent was waived by our Institutional Ethical Commission.

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Januś, D., Kalicka-Kasperczyk, A., Wójcik, M. et al. Long-term ultrasound follow-up of intrathyroidal ectopic thymus in children. J Endocrinol Invest 43, 841–852 (2020). https://doi.org/10.1007/s40618-019-01172-w

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