 Thyroid Tumors
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A thyroid tumor is a cystic or solid mass that occurs in the thyroid, a butterfly-shaped gland that is located in the neck, just below the Adam's apple. The thyroid gland makes and stores hormones that regulate growth and development in childhood. Hormones made in the thyroid gland also regulate metabolism (the rate at which food is converted to energy) body temperature, blood pressure, heart rate, and affect the muscles, the nervous system and other organs.
A thyroid tumor can be benign or malignant (cancerous.) Most patients with a small solitary thyroid lump, known as a nodule, most likely have a benign lesion. However, thyroid cancer is a definite possibility in all patients. A cancerous thyroid tumor, known as thyroid carcinoma, can metastasize (spread) to other parts of the body. Although thyroid carcinoma can occur at any age, it is usually found in young people ages 15 to 19.
There are four types of thyroid cancer:
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- papillary - develops in cells that produce thyroid hormones containing iodine. This type of cancer grows very slowly and can usually be treated successfully, even if it has spread to nearby lymph nodes.
- follicular - also develops in cells that produce thyroid hormones containing iodine. However, this type of cancer can be difficult to control if it spreads to the neck or blood vessels.
- medullary - develops in cells that produce calcitonin, a hormone that does not contain iodine. This cancer tends to spread to other parts of the body.
- anaplastic - the fastest growing of the thyroid cancers, with extremely abnormal cells that grow and spread rapidly, especially locally in the neck itself.
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The cause of thryoid tumors is not completely understood. One known risk factor for certain types of thyroid cancer is exposure to radiation therapy for other problems at an early age. Another type of thyroid cancer, called medullary thyroid cancer, may have an alteration in a gene called the RET gene that can be inherited.
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The following are the most common symptoms of a thyroid tumor. However, each child may experience symptoms differently. Symptoms may include, but are not limited, to the following:
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- a lump in the neck
- swollen lymph nodes
- a tight or full feeling in the neck
- trouble with breathing or swallowing, hoarseness
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The symptoms of thyroid tumors may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.
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In addition to a complete medical history and physical examination of your child, diagnostic procedures to determine whether a tumor in the thyroid is cancerous or benign may include:
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- head and neck examination - your child's physician will feel the head and neck area for unusual lumps
- blood tests - a measure of levels of certain substances in the blood will tell how well the thyroid is functioning
- ultrasound (also called sonography) - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.
- radioactive iodine scan - to outline abnormal areas of the thyroid, a small amount of a radioactive substance is given to the patient; a scanner detects areas in the thyroid that do no absorb iodine in the normal way
- surgery - in some cases, your child's doctor may decide that the most accurate way to determine whether the tumor is malignant is to perform an operation known as a thyroid lobectomy. For this procedure a pediatric surgeon will remove a lobe of the thyroid gland that contains the tumor, for analysis. . This diagnostic procedure also contributes to treatment of the tumor by removing it. Other surgical diagnostic methods include biopsy of the tumor, either by a needle or an operation. For this procedure, a sample of tissue is removed from the tumor and examined under a microscope.
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Specific treatment for your child's thyroid tumor will be determined by your child's physician based on:
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- your child's age, overall health, and medical history
- whether the tumor is cancerous or benign
- extent of the disease
- your child's tolerance of specific medications, procedures, or therapies
- how your child's physician expects the disease may progress
- your opinion or preference
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Treatment may include:
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- surgery - surgery is used to remove as much of the tumor as possible either by lobectomy or subtotal thyroidectomy. Depending on the extent of the condition, your child's pediatric surgeon may remove the entire thyroid, in a procedure called a total thyroidectomay.
- radioactive iodine therapy - If the tumor is cancerous, radioactive iodine medication destroys cancer cells that are left after surgery and help prevent the disease from returning
- hormone therapy - given to patients who have had surgery to remove the thyroid gland and who have undergone radioactive iodine treatment to replace normal hormones and slow the growth of cancer cells. Thyroid hormone may need to be administered throughout your child's life.
- chemotherapy - if cancer has spread to other parts of the body, chemotherapy may be given. This drug treatment works by interfering with the cancer cell's ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells and shrink tumors. Chemotherapy may be used alone for some types of cancer or in conjunction with other therapy such as radiation or surgery. Often, a combination of chemotherapy drugs is used to fight a specific cancer. Certain chemotherapy drugs may be given in a specific order depending on the type of cancer it is being used to treat. While chemotherapy can be quite effective in treating certain cancers, the agents do not differentiate normal healthy cells from cancer cells. Because of this, there can be many adverse side effects during treatment. Being able to anticipate these side effects can help the care team, parents, and child prepare, and, in some cases, prevent these symptoms from occurring, if possible. Chemotherapy is systemic treatment, meaning it is introduced to the bloodstream and travels throughout the body to kill cancer cells. Chemotherapy can be given:
- as an injection into the muscle or fat tissue
- intravenously (directly to the bloodstream; also called IV)
- intrathecally - chemotherapy given directly into the spinal column with a needle
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Children's Hospital and Dana-Farber Cancer Institute are conducting numerous research studies that will help clinicians better understand and treat thyroid carcinoma.
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