Years of experience support the safe use of fine-needle aspiration for pediatric thyroid nodules

Ultrasound-guided fine-needle aspiration (FNA) has long been used as a safe and effective way to evaluate thyroid nodules in adults, usually without sedation. Less is known about the safety and tolerability of FNA in children, although small studies suggest that the approach can be performed without sedation and with minimal complications. Now, a report by the team in Boston Children’s Thyroid Center bolsters those findings.

The Center’s clinicians have used FNA to evaluate pediatric thyroid nodules for more than a quarter century. In a recent retrospective study, they evaluated patient-reported pain, complication rates, and the use of sedation in pediatric thyroid FNA procedures. The team, led by the Center’s Medical Director, Ari Wassner, MD, reviewed 26 years of data, including 496 pediatric patients and 727 FNA procedures, 97 percent of which were performed without sedation, some in children as young as age 5. Sedation was used mostly for patients who were very young or had developmental delays and was requested by the patient or family in only about 1 percent of procedures.

A safe and effective option for evaluating thyroid nodules

Patients who completed pain scale surveys after undergoing FNA generally reported mild pain from the procedure — a median of 3 out of 10, which is similar to the pain reported by children having routine needle sticks (like a blood draw). In addition, there were no clinically significant complications of FNA, including no episodes of bleeding or infection.

The results — published in the journal Thyroid — suggest that, with appropriate pain management techniques, the vast majority of pediatric thyroid FNA can be performed safely, with only mild discomfort, and without sedation.

“Based on our experience, a skilled medical team working together with patients and their families can make FNA quick, safe, and comfortable for the vast majority of children and adolescents. This should allow most children and their families to avoid the risks, effort, and cost of undergoing sedation and to get the answers they need quickly,” says Wassner.

Takeaways for your practice

• FNA is the recommended approach for evaluating thyroid nodules and is safe and effective in children.
• More than 25 years of experience show that FNA can be performed safely, with only mild pain, and without sedation in most pediatric patients.

Learn more about the Thyroid Center.