Thyroid Cancer in Children | Diagnosis & Treatments

How is thyroid cancer diagnosed in children?

The first step in treating a child with thyroid cancer is forming an accurate and complete diagnosis. In addition to a medical history and physical exam, a physician may order a number of different tests to diagnose thyroid cancer and determine whether it has spread.

  • Blood tests are used determine if the thyroid is working properly.
  • Ultrasound is the best imaging technique to visualize a known or suspected thyroid nodule. Ultrasound uses sound waves to assess the location and characteristics of nodules in the thyroid gland. Because ultrasound uses only sound waves, it does not expose the patient to any harmful radiation.
  • Fine-needle aspiration (sometimes called a biopsy) uses a very thin needle to take a sample of a thyroid nodule and/or lymph nodes to gather information about whether the thyroid nodule may be a thyroid cancer.
  • Surgery is sometimes needed to determine whether a thyroid nodule is a thyroid cancer, if the result of fine-needle aspiration (biopsy) is not definitive.
  • Computerized tomography (CT or CAT) scan is sometimes needed to take detailed images of the neck or chest, to help determine what surgery or other treatments are needed.
  • Genetic testing is useful in many cases to determine whether a thyroid cancer may be part of an underlying genetic condition.

Your doctor may discuss other diagnostic tests with you depending on your child’s individual situation. After we complete all necessary testing, our experts will meet together to review and discuss what they have learned about your child's condition. Then we will meet with you and your family to discuss the results and outline the best possible treatment options.

How is thyroid cancer treated in children?

Your child’s care will vary depending on the specific type of thyroid cancer they have. Components of thyroid cancer treatment may include the following.

Surgery is the first and most important treatment for thyroid cancer. Thoroughly and safely removing as much of the tumor as possible is important to ensure the best possible long-term outcome. This often includes removing the entire thyroid gland, and if necessary any lymph nodes in the neck that may contain thyroid cancer. This allows your doctors to form a complete diagnosis of the cancer type and obtain information on the stage of the disease, which will help determine if any further treatments are necessary.

Thyroid surgery is generally safe but rarely can have serious complications. For this reason, it is important that the procedure be performed by an experienced thyroid surgeon. Our thyroid surgeons have extensive experience in pediatric thyroid surgery and work closely with the rest of the Thyroid Center team to provide seamless, coordinated care before, during, and after surgery.

Radioactive iodine therapy may be recommended to destroy any remaining cancer cells after surgery. This therapy uses the natural need of thyroid cells for iodine to treat thyroid cancer cells that may remain in the body after surgery. Radioactive iodine is absorbed by and destroys these remaining thyroid cells, even if they are located in areas that cannot be removed by surgery (like the lungs). In patients with high-risk thyroid cancer, radioactive iodine therapy can improve outcomes and reduce the risk of thyroid cancer recurrence. Radioactive iodine can only be used to treat differentiated types of thyroid cancers, not medullary thyroid cancers.

Hormone therapy is used to replace normal hormones and slow the growth of cancer cells. If the entire thyroid was removed, lifelong treatment with thyroid medication is needed. In patients with high-risk thyroid cancer, giving a slight excess of thyroid medication may improve outcomes and reduce the risk of thyroid cancer recurrence.

Molecular therapies may be effective for patients with advanced differentiated thyroid carcinoma that does not respond to surgery and radioactive iodine therapy, and for patients with advanced medullary thyroid carcinoma. Many of these new, experimental therapies are available in our Thyroid Center as part of research trials.

What is the long-term outlook for children with thyroid cancer?

The prognosis for children with thyroid cancer is excellent, with a long-term survival rate of greater than 95 percent. Outcomes are best when thyroid cancer is detected and treated early.

Children treated for thyroid cancer have higher recurrence rates than adults, especially those with tumors that have spread to the lymph nodes or other sites. Postoperative treatment with radioactive iodine or hormone therapy may help reduce the risk of recurrent disease. Even if disease does recur, outcomes for children with recurrent disease are excellent.

You and your child will need to work with your medical team to monitor the effects of treatment after your child's cancer is in remission. This will likely include visiting the Thyroid Center every year to monitor for recurrence and to manage possible disease complications. The Thyroid Center provides comprehensive follow-up evaluations from their cancer care team, which includes endocrinologists, surgeons, radiologists, oncologists, genetic counselors, social workers, and psychologists.