Does exposure to childhood radiation influence the development of thyroid nodular disease and thyroid cancer risk?

This Practice Point commentary discusses the findings and limitations of a retrospective analysis by Mihailescu and Schneider, in which the authors investigated the prevalence of thyroid nodular disease and thyroid cancer in a cohort of patients exposed to ionizing radiation during childhood. Thyroid nodular disease and thyroid cancer were both prevalent in this population. Contrary to previous hypotheses, however, multinodularity was not associated with a decreased risk of malignancy, as thyroid cancer was diagnosed in 30.7% of patients with two or more thyroid nodules, each larger than 1 cm. In this commentary, I highlight strategies that are critical to effective patient care. When present, multiple thyroid nodules larger than 1 cm must be evaluated by fine-needle aspiration cytology in order to reliably exclude thyroid cancer. Although retrospective in design, this investigation provides insight into the natural history of thyroid disease in a unique patient cohort.