Childhood Thyroid Cancer Treatment (PDQ®)—Health Professional Version - National Cancer Institute

Childhood Thyroid Cancer Treatment (PDQ®)—Health Professional Version - National Cancer Institute

Childhood Thyroid Cancer Treatment (PDQ®)–Health Professional Version

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THYROID CANCER

• Patient
• Health Professional
  • Thyroid Cancer Treatment
  • Childhood Thyroid Cancer Treatment
  • Genetics of Endocrine & Neuroendocrine Neoplasias
  • Thyroid Cancer Screening
• Research

SECTIONS

• Incidence
• Risk Factors
• Histology
• Molecular Features and Tumor Characteristics
• Clinical Presentation and Outcome
• Diagnostic Evaluation
• Treatment of Papillary and Follicular Thyroid Carcinoma
• Treatment of Recurrent Papillary and Follicular Thyroid Carcinoma
• Treatment of Medullary Thyroid Carcinoma
• Special Considerations for the Treatment of Children With Cancer
• Changes to This Summary (01/​09/​2018)
• About This PDQ Summary
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Diagnostic Evaluation

Initial evaluation of a child or adolescent with a thyroid nodule includes the following:

• Ultrasound of the thyroid.
• Serum thyroid-stimulating hormone (TSH) level.
• Serum thyroglobulin level.

Tests of thyroid function are usually normal, but thyroglobulin can be elevated.

Fine-needle aspiration as an initial diagnostic approach is sensitive and useful. However, in doubtful cases, open biopsy or resection should be considered.[1-4] Open biopsy or resection may also be preferable for young children (refer to Table 2).

Table 2. Thyroid Carcinomas in Children

ENLARGE

Histology	Associated Chromosomal Abnormality	Presentation	Diagnosis	Treatment
EGF = epidermal growth factor; 131I = iodine I 131; MEN2 = multiple endocrine neoplasia type 2; TSH = thyroid-stimulating hormone.
Differentiated thyroid carcinoma	RET/PTC more common in children. BRAFV600E mutations occur with similar frequency in children and adults. Association with rare hereditary tumor syndromes: APC-associated polyposis, DICER1syndrome, Carney complex, PTENhamartoma tumor syndrome, Werner syndrome.	Thyroid mass. Prepubertal children more often with nodal and lung metastases.	Ultrasound, TSH, thyroglobulin. Fine needle or open biopsy.	Total or near-total thyroidectomy; 131I; thyroid hormone. In metastatic or recurrent disease, tyrosine kinase or EGF receptor inhibitors may be of benefit.
Medullary thyroid carcinoma	MEN2	Aggressive. 50% with metastases at presentation.	In familial MEN2, RETtesting.	Aggressive surgical intervention. Prophylactic thyroidectomy is indicated in familial cases.

References

1. Willgerodt H, Keller E, Bennek J, et al.: Diagnostic value of fine-needle aspiration biopsy of thyroid nodules in children and adolescents. J Pediatr Endocrinol Metab 19 (4): 507-15, 2006. [PUBMED Abstract]
2. Stevens C, Lee JK, Sadatsafavi M, et al.: Pediatric thyroid fine-needle aspiration cytology: a meta-analysis. J Pediatr Surg 44 (11): 2184-91, 2009. [PUBMED Abstract]
3. Bargren AE, Meyer-Rochow GY, Sywak MS, et al.: Diagnostic utility of fine-needle aspiration cytology in pediatric differentiated thyroid cancer. World J Surg 34 (6): 1254-60, 2010. [PUBMED Abstract]
4. Redlich A, Boxberger N, Kurt Werner S, et al.: Sensitivity of fine-needle biopsy in detecting pediatric differentiated thyroid carcinoma. Pediatr Blood Cancer 59 (2): 233-7, 2012. [PUBMED Abstract]

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Clinical Presentation and Outcome

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Treatment of Papillary and Follicular Thyroid Carcinoma

• Updated: January 9, 2018