Cold thyroid nodules in childhood: is surgery always necessary?

In children who present with a cold thyroid nodule the current recommendation is that surgery immediately be performed in view of the high probability of thyroid cancer. Because the incidence of thyroid cancer in children may be decreasing and because extensive experience has been gained in adults with thyroid echography and fine-needle aspiration cytology, we evaluated three consecutive children with cold thyroid nodules by means of these non-surgical techniques. The diagnoses were: thyroid cancer in one patient, thyroid abscess in one and haemorrhagic cyst of the thyroid in one. In the latter two patients, fine-needle aspiration was both diagnostic and therapeutic. We conclude that thyroid echography and fine-needle aspiration of thyroid nodules deserve more extensive evaluation in the paediatric age group.