Thyroid Cancer in Children

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Pediatric thyroid cancer can be cured when found early and treated effectively. Duke's pediatric comprehensive thyroid clinic includes a team of experts dedicated to the assessment and treatment of children with thyroid nodules and thyroid cancer. We work with you to identify the nature of your child’s thyroid condition.

Pediatric endocrinologists coordinate your child’s evaluation and treatment with pediatric radiologists, thyroid surgeons, nuclear medicine physicians, pathologists, pediatric oncologists, and geneticists to provide the highest quality care. We treat your child effectively, help them remain cancer-free, and minimize long-term complications caused by cancer treatments.

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About Pediatric Thyroid Nodules and Thyroid Cancer

Although most thyroid nodules in children are benign, approximately one-fourth are thyroid cancer. Certain characteristics of a nodule, including its size, shape, and appearance, increase its likelihood of being thyroid cancer. Additionally, some children have an increased risk of developing thyroid nodules and thyroid cancer. For this reason, all thyroid nodules in children should be evaluated by a pediatric endocrinologist. Our pediatric endocrinologists work closely with Duke pediatric oncologists, radiation oncologists, and geneticists to identify and follow children who are at higher risk for thyroid cancer for medical or genetic reasons. Types of thyroid cancer and risk factors for thyroid cancer include the following:

Papillary Thyroid Cancer
This is the most common type of thyroid cancer in children. It may spread to the lymph nodes or, less commonly, to the lungs, but is highly treatable if detected early and treated effectively.

Follicular Thyroid Cancer
Follicular thyroid cancer is the second most common type of thyroid cancer in children. It can spread to lymph nodes as well as other organs. This type of cancer can be cured when identified and treated early.

Medullary Thyroid Cancer
In children, medullary thyroid cancer is typically caused by an inherited syndrome called multiple endocrine neoplasia type 2 (MEN2). Medullary thyroid cancer is a serious form of thyroid cancer and can be harder to treat when it spreads beyond the thyroid gland. For this reason, many children with MEN2 have their thyroid glands removed before cancer develops. If MEN2 runs in a family, all family members, including children, should have genetic testing to determine if they are affected. If MEN2 is suspected or confirmed in a child, they should see a pediatric endocrinologist.

Genetic Conditions
MEN2, DICER1 syndrome, familial adenomatous polyposis (FAP), Gardner syndrome, Carney complex, Werner syndrome, and PTEN hamartoma tumor syndrome are some genetic conditions associated with thyroid nodules and thyroid cancer. We work closely with Duke's pediatric geneticists to identify children at risk.

Thyroid Cancer Following Radiation Treatment
Children and adolescents who have received radiation to the head, neck, and chest to treat a different type of cancer have an increased risk for thyroid cancer.

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Diagnosing Thyroid Cancer in Children

If your child has a thyroid nodule, we may perform one or more tests to determine if they have thyroid cancer.

Physical Exam

Your doctor reviews your child’s history and feels the neck for signs of an enlarged thyroid, thyroid nodules, or swollen lymph nodes.

Blood Tests

We use blood tests to measure levels of certain hormones, including T4, T3, thyroid stimulating hormone (TSH), and in some cases calcitonin to determine if the thyroid gland is working properly. Blood tests can also detect thyroid antibodies, which tell us if your child’s immune system is attacking the thyroid gland.

Genetic Tests

Genetic testing can determine if there are genetic mutations causing MEN2 or other conditions that increase your child’s risk for thyroid cancer.

Thyroid Ultrasound

This test uses sound waves to create pictures of the thyroid gland and nearby lymph nodes. Ultrasounds help determine if a lump in the neck is a thyroid nodule and if the nodule has certain features that might be signs of cancer.

Radioactive Thyroid Scan

Healthy thyroid glands absorb iodine from the diet and use it to make thyroid hormones. During a thyroid scan, your child swallows (or is injected with) a tiny amount of radioactive iodine. A machine that can see radioactive material helps show where thyroid tissue is located and if the thyroid gland is working properly.

Biopsy (Fine Needle Aspiration)

A pediatric radiologist uses a small needle to remove tissue from a thyroid nodule or a lymph node. The tissue is analyzed by pathologists for the presence of cancer cells.

Molecular Testing

Sometimes the pathologists cannot tell if a nodule is benign or is cancer based on the biopsy alone. In these cases, molecular tests can be done to help determine the likelihood of cancer. Not every center offers this testing for children, but the Duke pediatric comprehensive thyroid clinic does.

Follow-Up Tests

Following thyroid cancer treatment, your child will need ongoing physical exams, lab tests, and radiologic imaging to make sure the cancer hasn’t returned.

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Treatments

Treatments are selected to address your child’s individual needs and thyroid condition. Our goal is to restore your child’s hormone levels to normal to alleviate symptoms and prevent complications. In addition to providing the highest quality medical and surgical care, we attend to the psychosocial concerns of your child and your family.

Surgery

Surgery is the initial treatment for thyroid cancer. It often requires removal of the entire thyroid gland (total thyroidectomy). Nearby lymph nodes may also be removed. Some nodules are treated by removing only part of the thyroid gland (thyroid lobectomy). If the entire gland is removed, your child will take a daily dose of synthetic thyroid hormone that will maintain normal thyroid function.

Radioactive Iodine Ablation

In some cases, a child may be given an oral dose of radioactive iodine that is high enough to destroy the thyroid gland. In children with thyroid cancer, this treatment may be used after surgery to destroy any lingering cancer cells. Once the thyroid gland is destroyed, your child will take a daily dose of synthetic thyroid hormone that will insure normal growth, development, and long-term reproductive function.

Medication

Following removal of the entire thyroid gland, a child will need to take synthetic thyroid hormone for the rest of their life. Fortunately, this medication can ensure that they will have normal growth, development, school performance, and reproductive function.

Best Children's Hospital in NC

Duke Children's Hospital & Health Center is proud to be nationally ranked in 10 pediatric specialties.

Why Choose Duke

Comprehensive Thyroid Cancer Treatment
The Duke pediatric comprehensive thyroid clinic was the first clinic in the region committed to expert, multidisciplinary care of pediatric patients with thyroid nodules and cancer. Our team of experts includes specialists in endocrinology, radiology, head and neck surgery, endocrine surgery, anesthesiology, oncology, and genetics. We have extensive expertise caring for children with thyroid nodules and thyroid cancer and ensure that your child will have the best medical and surgical care and psychosocial support.

Pediatric Thyroid Cancer Consultations and Second Opinions
We routinely consult with other doctors and provide second opinions to families when children have challenging conditions such as indeterminate thyroid nodules or persistent or recurrent thyroid cancer.

Experienced Surgeons Reduce Your Child’s Risk of Complications
Our endocrine surgeon performs hundreds of thyroid surgeries annually, which decreases your child’s risk of complications and improves outcomes. Research shows that children who need thyroid surgery have better outcomes when their surgeon performs at least 25 thyroidectomies a year.

Pediatric-Specific Treatment Guidelines
We use the latest pediatric-specific guidelines and recommendations to treat thyroid nodules and cancer. Thyroid cancer behaves differently in children compared to adults, so having care by pediatric experts is critical. Our team members are active in the American Thyroid Association.

Psychosocial Support
Our team includes counselors who specialize in long-term support for children and adolescents with cancer. We’ll help your child understand the diagnosis and cope with the impact of treatment.

Transition to Adult Endocrinology Care
Once your child reaches adulthood, we will help with the transition to an adult endocrinologist.

This page was medically reviewed on 06/08/2023 by

Laura C. Page, MD | Pediatric Endocrinologist