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