Thyroid Cancer Diagnosis & Treatment

Thyroid cancer doesn’t usually cause noticeable symptoms. Most often, the cancer is found in the following ways:

• Lump in the thyroid gland: A healthcare provider may detect a lump and swollen lymph nodes during a routine physical examination. If you find a lump or have other concerns, take the child for a medical exam.
• Nodule on a scan: A nodule on the thyroid gland may show up on a scan when the child has an imaging test for something else.

Rarely, thyroid cancer may cause other symptoms, such as increasing hoarseness or other changes to the voice, difficulty swallowing or pain in the neck and throat.

One type of medullary thyroid cancer stimulates the growth of nerve cells throughout the gastrointestinal tract, starting at the lip. A symptom is a bumpy lip or tongue.

Diagnosis

At your first visit, our pediatric endocrinologist will get your child’s medical history, do an exam and decide if blood tests, imaging tests and a biopsy are needed.

• History and physical examination: The doctor takes a careful history of the child and family. Has the child had radiation exposure? Have family members had an endocrine or thyroid cancer or a goiter? The doctor feels around the neck, carefully checking the thyroid gland. Is there a lump or goiter? Are there nodules? Are lymph nodes swollen?
• Ultrasound: We can use this noninvasive test to confirm the presence of a thyroid mass. We learn the size and shape of each nodule and whether the nodules are fluid-filled (usually not cancerous) or solid (may be cancerous). This helps us know the stage of the cancer. We can see if lymph nodes are enlarged. This imaging technology helps guide a fine-needle biopsy, too.Biopsy: Fine-needle aspiration is the most reliable way to diagnose thyroid cancer. Most children get this type of biopsy. We insert a thin needle into the nodule and remove cells or fluid from it. Looking at the sample under a microscope, the pathologist can usually identify the type of cancer. This procedure is safe and minimally invasive.
• Blood tests: Blood tests can tell us if the thyroid is functioning properly. We can, for example, collect a blood sample and measure the body’s level of thyroid-stimulating hormone. Other blood tests are used to detect tumors associated with medullary thyroid cancer.

Treatment

• Thyroid surgery
• Thyroid hormone treatment
• Radioactive iodine therapy

If appropriate, the doctor will plan additional treatment. For example, the child may need a second surgery or additional doses of radioactive iodine. External radiation may be used, for example, if the cancer returns and is in the bones. Chemotherapy is almost never used, but new “small molecule” medications which inhibit specific growth pathways (tyrosine kinase inhibitors) may be used for cancers that haven’t responded well to other treatments.

Thyroid Surgery

The surgery your child needs may be a thyroidectomy or a lobectomy. An incision is made at the base of the neck. As the situation requires, we remove all of the thyroid gland or part of it. Removing nearby lymph nodes may be part of the surgery, too.

The surgeon must be careful of the nerves for the vocal cords and of the parathyroid gland that regulates calcium in the blood. Lurie Children’s has personnel and technology in the operating room especially to protect the vocal nerve from injury.

Our care team will prepare your family for the surgery. You’ll know how to eat and what medical care is needed before, during and after the surgery. Usually, the child receives two to three days of care in the hospital after the surgery.

Thyroid Hormone Treatment

After surgery, the child takes a daily tablet of levothyroxine (thyroid hormone.) This medicine is needed throughout life to replace the thyroid hormone the body can no longer make. The medicine also slows the growth of any thyroid cancer cells still in the body. The tablet can be crushed and mixed with liquid, chewed or swallowed. It is important for the child to take the medicine every day. Side effects only arise if the dose is too high or too low. The doctor may adjust the dose if blood tests show a need for a change.

Radioactive Iodine Therapy

Radioactive iodine therapy can be used to destroy cancer cells that may be left after surgery. This treatment doesn’t work for medullary thyroid cancer. We are careful not to overuse this therapy because it is important to limit each child’s exposure to radiation. We monitor the child closely after surgery and proceed conservatively.

Check-Ups & Blood Tests

Your child’s ongoing care includes periodic check-ups. The doctor gets a careful history, does a physical examination and reviews blood test results. Sometimes, an image of the neck is needed or a whole-body radioactive iodine scan to see if any thyroid cells remain in the body. It depends on the type of cancer. The endocrinologist also adjusts the thyroid hormone dose as the child grows.