Thyroid Cancer in Children

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.

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.

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.