Thyroid Cancer in Children

What Are the Types of Pediatric Thyroid Cancer?

Your child’s doctor determines the type of thyroid cancer based on the affected cells and how they look under a microscope. Common types of pediatric thyroid cancer include:

• Papillary thyroid cancer: Almost all thyroid cancers (up to 90 percent) are the papillary type. This type tends to affect teens, grows slowly and starts in follicular cells. The cells form tiny, finger-like projections called papillae. Papillary thyroid cancer typically affects both sides of the gland. It may spread to lymph nodes in the neck, or less commonly, the lungs.
• Follicular thyroid cancer: This slow-growing cancer also starts in follicular cells. It typically affects just one side of the gland and rarely affects lymph nodes in the neck. However, it can spread to the lungs and bones. This type accounts for 5 percent to 10 percent of thyroid cancers.
• Medullary thyroid cancer: An inherited change (mutation) to the RET gene causes multiple endocrine neoplasia (MEN) type 2 syndromes. Children with MEN2 syndromes are at high risk for medullary thyroid cancer, which starts in parafollicular C cells. This type is more aggressive and can spread to lymph nodes in the neck, as well as the liver, bones and brain. Less than 5 percent of thyroid cancers are medullary.

What Causes Thyroid Cancer in Children?

Most cases of papillary and follicular thyroid cancer have no known cause. These cancers are more common in teenage girls but can also affect teen boys. A gene change causes medullary thyroid cancer. 

These factors can increase a child’s risk for thyroid cancer:

• Autoimmune thyroid disease, such as Hashimoto’s thyroiditis
• Family history of thyroid cancer or thyroid disease
• Radiation therapy to the chest or neck to treat a different cancer

What Are the Signs and Symptoms of Thyroid Cancer in Children? 

Most types of pediatric thyroid cancer grow slowly, over years. They don’t cause noticeable symptoms. In some cases, you may see or feel a lump in the front of your child’s neck. Your child may also have swollen lymph nodes (lymphadenopathy). 

How Is Pediatric Thyroid Cancer Diagnosed?

At Lurie Children’s, specialists in pediatric endocrinology, otolaryngology (ear, nose and throat) and surgery treat thyroid cancer. One of our specialists will examine your child’s neck to feel for a mass. They’ll review your child’s symptoms, as well as their family and medical history. 

Diagnostic tests for thyroid cancer include:

• Blood tests to measure thyroid hormones and antibodies (proteins) that can show how well the gland works
• Ultrasound to look for an enlarged thyroid, nodules and enlarged lymph nodes. 
• Image-guided fine needle aspiration (FNA) biopsy to remove cells from the thyroid and any enlarged lymph nodes and check them for cancer
• Genetic screening to look for gene changes and syndromes

How Is Thyroid Cancer in Children Treated?

Children with thyroid masses receive care from a multidisciplinary team of specialists at our Pediatric Thyroid Program. This team treats all types of pediatric thyroid conditions, including thyroid cancer and nodules. They tailor your child’s treatment to their unique diagnosis. 

Thyroid Surgery (Thyroidectomy)

Surgery to remove the entire thyroid gland (total thyroidectomy) is the main treatment. Pediatric head and neck surgeons at Lurie Children’s perform a high volume of these procedures, giving them deep expertise. They may also remove nearby lymph nodes during surgery. After surgery, your child will need lifelong thyroid hormone replacement therapy. 

Less commonly, a child will get a hemithyroidectomy. This surgery (also called thyroid lobectomy) removes two diseased lobes on one side of the thyroid gland. If the remaining lobes don’t make hormones as well as they should, your child will need thyroid hormone replacement therapy.

Thyroid Replacement Hormone Therapy

Thyroid hormone replacement therapy is a daily oral medication to replace the thyroid hormones no longer made by the body. It can take a few months after surgery to determine the correct dosage. During this time, your child receives more frequent blood tests to measure thyroid hormones and adjust dosages. We continue to monitor their hormone levels and make medication changes as your child grows older.

Prophylactic Thyroid Surgery

For children who have the gene mutation that causes medullary thyroid cancer, we closely monitor thyroid changes and remove the gland before cancer can develop. This preventive (prophylactic) surgery may take place as early as infancy, depending on a child’s unique risk factors. Our care team educates your family about this treatment option, helping you make the best choice for your child when the time comes. 

Radioiodine

After a total thyroidectomy, your child should no longer make a protein called thyroglobulin. If a blood test detects this protein, your child will get a thyroid scan. This test may indicate that thyroid cancer cells have spread beyond the thyroid gland (metastasized) to other parts of the body. Your child’s care team will also consider thyroglobulin levels and neck ultrasound results to determine next steps.

Some children who show evidence of metastatic thyroid cancer may need radioactive iodine (radioiodine) treatment. This treatment takes place in our hospital. Your child swallows a pill that contains a form of iodine. Cancer cells absorb this radioactive substance, which kills them. Your child goes home in less than 24 hours.

Immunotherapy

In rare instances where thyroid cancer doesn’t respond to radioiodine treatment, your child may receive immunotherapy. Tyrosine kinase inhibitors (TKI) target biomarkers in cancer cells, helping to destroy them. At Lurie Children’s multidisciplinary Pediatric Endocrine Program, our pediatric endocrinologists partner with pediatric cancer (oncology) specialists at Lurie Children’s to provide this treatment. 

Ongoing Care

After treatment, your child needs regular imaging and blood tests to check for cancer recurrence. Blood tests also help your child’s doctor monitor hormone levels and adjust hormone replacement dosages as your child grows. Their care team will discuss how often your child needs these tests. Thyroid cancer is considered a chronic condition, which means your child needs to see an endocrinologist for life.

What Is Lurie Children’s Approach to Caring for Children With Thyroid Cancer?

The Division of Endocrinology at Lurie Children’s treats more children with hormone disorders than any other hospital in Illinois. We’re a leading regional referral center for children with thyroid cancer.

Your child benefits from:

• Specialized thyroid program: Our Pediatric Thyroid Program is considered among the best in the country. A multidisciplinary team of specialists treats infants through young adults who have thyroid nodules and thyroid cancer, as well as those at high risk for medullary thyroid cancer. 
• Surgical expertise: Our head and neck surgeons perform a large volume of thyroid surgeries, giving them a high level of expertise you can trust. Surgery takes place at our Level I Children’s Surgery Center, the highest distinction from the American College of Surgeons (ACS). 
• Team approach: A team of experts reviews your child’s diagnostic tests and risk factors to make a diagnosis and customize a care plan. Our clinic brings together different specialists in one location, making it easier for your child to get the services they need. 
• Genetic counseling: Experts at our Cancer Predisposition Program help families who have hereditary cancer syndromes that increase thyroid cancer risk. Our specialists can help you understand how a genetic mutation may affect your family and future generations. 
• Support for your child: Our Child Life Specialists help ease your child’s concerns about diagnostic tests and surgery. We also have social workers who work with your family to ensure your child receives hormone replacement therapy as prescribed. 
• Evidence-based care: Our doctors are active in national endocrinology research and clinical trials to improve the lives of children with thyroid disease. This includes participation in the Child and Adolescent Thyroid Consortium (CATC), an international research program.

Pediatric Endocrinology at Lurie Children’s 

At Lurie Children’s, your child receives care at the state’s largest and most experienced pediatric endocrinology program. U.S. News & World Report ranks our program among the top 12 in the country. We partner with your family, providing the latest therapies and compassionate care to help your child feel better and enjoy a fulfilling life.

Learn more about our Division of Pediatric Endocrinology