Thyroid Cancer in Children

Pediatric thyroid cancer can be cured when found early and treated effectively. Duke's team of experts is 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. We treat your child effectively, help your child remain cancer-free, and minimize long-term complications caused by cancer treatments.

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About Pediatric Thyroid Nodules and Thyroid Cancer

A thyroid nodule is typically a benign growth on the thyroid gland. However, certain characteristics of a nodule, including its size, shape and appearance, increase its likelihood of being thyroid cancer. For this reason, all thyroid nodules in children should be evaluated by a specialist. Our pediatric endocrinologists work closely with Duke pediatric oncologists, radiologists, and geneticists to identify and follow children who are at higher risk for thyroid cancer for medical or genetic reasons. The reasons and types of thyroid cancer may include the following.

Thyroid Cancer Following Radiation Treatment
The rate of teenagers with thyroid cancer has increased during the past 30 years. While the reason is unknown, it may be related to an increase in thyroid problems following radiation treatment for other forms of cancer like leukemia. In addition, doctors may now be more aware of the risks of thyroid cancer in certain families or in certain conditions associated with inflammation of the thyroid.

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 usually contained within one thyroid nodule. It is less likely to spread to the lymph nodes, but can spread to other organs. This type of cancer can be cured when identified and treated early.

Medullary Thyroid Cancer
In children, medullary thyroid cancer is most often 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.

Genetic Conditions
Multiple endocrine neoplasia type 2 (MEN2), DICER1 syndrome, familial adenomatous polyposis (FAP), Gardner syndrome, Carney complex, Werner syndrome, and PTEN hamartoma tumor syndrome are genetic conditions that can cause thyroid cancer. We work closely with Duke's pediatric geneticists to identify children at risk.

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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 your child has 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 tells 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 of 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 special camera 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 for the presence of cancer cells.

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 in order to alleviate symptoms and prevent complications. In addition to providing the highest quality of 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 benign 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 oral doses of radioactive iodine that are 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 his or her life. Fortunately, this medication can insure that your child 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 nine pediatric specialties.

Why Choose Duke

Comprehensive Thyroid Cancer Treatment
Our team of pediatric experts includes specialists in endocrinology, radiology, head and neck surgery, anesthesiology, cancer, and genetics. They have extensive expertise caring for children with thyroid nodules and thyroid cancer and insure 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.

Experienced Surgeons Reduce Your Child’s Risk of Complications
Our endocrine surgeons perform hundreds of thyroidectomies annually, which increases your child’s chance of having a positive outcome. Our research showed 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 pediatric-specific guidelines to treat thyroid nodules and cancer, unlike medical centers where adult specialists use adult treatment guidelines to treat children. It is important to use pediatric-specific guidelines because these conditions can behave differently in children, and aggressive treatments geared for adults can cause long-term complications in children.

Psychosocial Support
Our team includes a counselor who specializes 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 him or her transition care to an adult endocrinologist.

Reviewed: 01/02/2019