Episode Details

Pediatric thyroid nodules are rare, but their risk of malignancy is significantly higher than in adults, raising the stakes for accurate diagnosis and multidisciplinary management. In this episode of the BackTable ENT Podcast Dr. Gopi Shah and co-host Dr. Jeff Hyzer interview Dr. Wen Jiang, pediatric otolaryngologist at Rady Children’s Hospital in San Diego, for an in-depth discussion on the evaluation and management of thyroid nodules in children.

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Timestamps

00:00 - Introduction
02:27 - Thyroid Nodule Risks and Care Team
06:47 - Age-related Differences in Nodule Presentation and Outcomes
08:50 - Initial workup
13:42 - Ultrasound Interpretation
16:07 - Lymph Node Mapping and CT
19:58 - Incidental Findings
24:14 - Role of FNA, Molecular Testing, and Radiofrequency Ablation
32:40 - Molecular Testing Results and Counseling
38:04 - Neck Dissection Strategy
40:44 - Hypocalcemia Protocol Considerations
44:01 - Parathyroid and Recurrent Laryngeal Nerve Dissection Tips
47:33 - Postop Care and Follow-up
51:25 - Using Radioactive Iodine and Targeted Therapy
54:55 - AI’s and Ultrasound and Final Thoughts

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More about this episode

Dr. Jiang highlights the key differences between pediatric and adult thyroid nodules. She describes her multidisciplinary approach including collaboration with radiology, pathology, endocrinology and nuclear medicine. The discussion reviews the initial workup for pediatric thyroid nodules and why ultrasound remains the primary diagnostic tool. She also discusses situations where CT with contrast can be helpful for surgical planning. This episode explores the growing role of reflex molecular testing in guiding management decisions and outlines the impacts of molecular testing results. Dr. Jiang shares her approach to patient counseling along with management of calcium and PTH after surgery. The conversation concludes with emerging applications of molecular diagnostics and AI models for improving thyroid ultrasound interpretation.

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Resources

Dr. Jiang's Research on Pediatric Thyroid Nodule Management - https://pubmed.ncbi.nlm.nih.gov/26770219/

Bethesda System for Thyroid Cytopathology - https://pmc.ncbi.nlm.nih.gov/articles/PMC7182964/

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