Thyroid Ultrasonography as an Early Diagnostic Tool for Autoimmune Thyroiditis in Children and Adolescents with Simple Goiter

Background Autoimmune thyroiditis (AITD), the leading cause of diffuse thyroid disease in children and adolescents, can severely impact development if undetected. Many pediatric patients present with goiter despite normal thyroid function, creating diagnostic uncertainty. The role of thyroid ultrasonography (US) as an early screening tool to identify high-risk patients before biochemical dysfunction remains underexplored. Methods From January 2000 through January 2024, 88 consecutive children and adolescents with goiter and normal thyroid function underwent thyroid US and biochemical evaluation of thyroid autoimmunity within 3 months. Patients were subcategorized into AITD (n = 34) and non-AITD (n = 54) groups based on thyroid antibody status. Clinical features, laboratory data, and US findings were analyzed, including echogenicity, echotexture, vascularity, and combined US abnormalities for risk stratification. Chi-square test, Fisher's exact test, independent two-sample t-test, and multivariate logistic regression were used for statistical analysis. Results The AITD group showed significantly higher family history of AITD (26.5% vs. 9.3%, p = 0.03) and older age (14.29 ± 4.06 vs. 11.56 ± 3.88 years, p = 0.01) compared to non-AITD group. US findings showed more hypoechogenicity (41.2% vs. 3.7%), heterogeneity (85.3% vs. 33.3%), and increased vascularity (76.5% vs. 25.9%) in AITD patients (all p < 0.001). Combined US abnormalities (≥ 2 findings) demonstrated 85.3% sensitivity with odds ratio 10.49 (95% CI: 3.21–34.32, p < 0.01). Conclusions Hypoechogenicity, heterogeneity, increased vascularity, older age, and family history were significantly associated with AITD. Combined US abnormalities showed substantial discriminatory power for risk stratification. Early thyroid US can serve as a valuable risk stratification tool to guide timing and prioritization of serological testing in pediatric goiter evaluation.