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Thyroid Tumors in Children

Thyroid Tumors in Children Related Articles

What Is Thyroid Cancer?

Thyroid tumors form in the tissues of the thyroid gland. The thyroid gland is a butterfly-shaped gland at the base of the throat near the windpipe. The thyroid gland makes important hormones that help control growth, heart rate, body temperature, and how quickly food is changed into energy.

The number of new cases of thyroid cancer in children, adolescents, and young adults has increased in recent years. Childhood thyroid tumors are more common in girls and children aged 15 to 19 years.

Thyroid tumors may be adenomas (noncancer) or carcinomas (cancer).

Adenoma

Adenomas can grow very large and sometimes make hormones. Adenomas may become malignant (cancer) and spread to the lungs or lymph nodes in the neck.

Carcinoma

There are three types of thyroid cancer:

Papillary. Papillary thyroid carcinoma is the most common type of thyroid cancer in children. It often spreads to the lymph nodes and may also spread to the lung. The prognosis (chance of recovery) for most patients is very good.

Follicular. Follicular thyroid carcinoma often spreads to the bone and lung. Sometimes it is inherited (passed from the parent to the child). The prognosis for most patients is very good.

Medullary. Medullary thyroid carcinoma is often inherited. It may have spread to other parts of the body at the time of diagnosis. The prognosis depends on the size of the tumor at the time of diagnosis.

Papillary and follicular thyroid carcinoma are often referred to as differentiated thyroid carcinoma.

What Are the Risk Factors for Thyroid Cancer in Children?

The risk of thyroid cancer is increased by the following:

Being exposed to radiation, such as radiation treatment to the neck or atomic bomb radiation.

Having certain genetic syndromes, such as multiple endocrine neoplasia type 2A (MEN2A) syndrome, multiple endocrine neoplasia type 2B (MEN2B) syndrome, APC associated polyposis, DICER1 syndrome, Carney complex, PTEN hamartoma tumor syndrome, and Werner syndrome.

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

Thyroid tumors may cause any of the following signs and symptoms. Check with your child’s doctor if your child has any of the following:

  • A lump in the neck.
  • A lump near the collarbone that does not hurt.
  • Trouble breathing.
  • Trouble swallowing.
  • Hoarseness or a change in the voice.
  • Hyperthyroidism (irregular heartbeat, shakiness, weight loss, trouble sleeping, frequent bowel movements, and sweating).

Other conditions that are not thyroid tumors may cause these same signs and symptoms.

Sometimes thyroid tumors do not cause any signs or symptoms.

How Is Thyroid Cancer in Children Diagnosed?

Tests to diagnose and stage thyroid tumors may include the following:

  • Physical exam and history.
  • Fine-needle aspiration (FNA) biopsy.
  • Open biopsy. The biopsy may be done at the same time as surgery to remove all or part of the thyroid.
  • X-ray. A chest x-ray may be done if the lymph nodes in the neck are large.
  • CT scan.
  • MRI.

Other tests used to diagnose and stage thyroid tumors include the following:

Ultrasound: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later. This procedure can show the size of a thyroid tumor and whether it is solid or a fluid-filled cyst. Ultrasound may be used to guide a fine-needle aspiration (FNA) biopsy. A complete ultrasound exam of the neck is done before surgery.

Thyroid function test: The blood is checked for abnormal levels of thyroid-stimulating hormone (TSH). TSH is made by the pituitary gland in the brain. It stimulates the release of thyroid hormone and controls how fast follicular thyroid cells grow. The blood may also be checked for high levels of the hormone calcitonin.

Thyroid scan: If the amount of thyroid stimulating hormone in the child's blood is low, a scan to make images of the thyroid may be done before surgery. A small amount of a radioactive substance is swallowed or injected. The radioactive material collects in the thyroid gland. A special camera linked to a computer detects the radiation given off and makes pictures that show how the thyroid looks and functions.

Thyroglobulin test: The blood is checked for the amount of thyroglobulin, a protein made by the thyroid gland. Thyroglobulin levels are low or absent with normal thyroid function but may be higher with thyroid cancer or other conditions.

What Is the Treatment and Prognosis for Thyroid Cancer in Children?

Treatment of papillary and follicular thyroid carcinoma in children may include the following:

  • Surgery to remove the thyroid gland and lymph nodes with cancer, followed by radioactive iodine (RAI) to kill any thyroid cancer cells that are left. Hormone replacement therapy (HRT) is given to make up for the lost thyroid hormone.
  • Radioactive iodine (RAI) for cancer that has recurred (come back).

Within 12 weeks of surgery, tests are done to find out if thyroid cancer remains in the body. These may include thyroglobulin tests and RAI scans. A radioactive iodine scan (RAI scan) is done to find areas in the body where thyroid cancer cells that were not removed during surgery may be dividing quickly. RAI is used because only thyroid cells take up iodine. A very small amount of RAI is swallowed, travels through the blood, and collects in
thyroid tissue and thyroid cancer cells anywhere in the body. Further treatment depends on whether cancer cells remain in the body:

  • If no cancer cells are found outside the thyroid, a larger dose of RAI is given to destroy any remaining thyroid tissue.
  • If cancer remains in the lymph nodes or has spread to other parts of the body, an even larger dose of RAI is given to destroy any remaining thyroid tissue and thyroid cancer cells.

A whole-body SPECT (single photon emission computed tomography) scan may be done 4 to 7 days after treatment with RAI, to see if there are areas with cancer cells. A SPECT scan uses a special camera linked to a computer to make 3-dimensional (3-D) pictures of areas inside the body.

A very small amount of a radioactive substance is injected into a vein. As the substance travels through the blood, the camera rotates around the body and takes pictures. Areas where thyroid cancer cells are growing will show up brighter in the picture. This procedure may be done just before or after a CT scan.

It is common for thyroid cancer to recur (come back), especially in children younger than 10 years and those with cancer in the lymph nodes. Ultrasound and thyroglobulin tests may be done from time to time to check if the cancer has recurred. Lifelong follow-up of thyroid hormone levels in the blood is needed to make sure the right amount of hormone replacement therapy (HRT) is being given. Talk with your child's doctor to find out how often these tests need to be done.

Treatment of medullary thyroid carcinoma in children may include the following:

  • Surgery to remove the tumor.
  • Targeted therapy with kinase inhibitors for cancer that has spread to other parts of the body or that has recurred.

The prognosis (chance of recovery) depends on the following:

  • The child's gender.
  • The size of the tumor.
  • Whether the tumor has spread to lymph nodes or other parts of the body at the time of diagnosis.

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Reviewed on 11/8/2017
References
SOURCE:

The website of the National Cancer Institute (https://www.cancer.gov)

Last updated Oct. 6, 2017
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