Childhood Thyroid Cancer Treatment (PDQ®)–Patient Version

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THYROID CANCER

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General Information About Childhood Thyroid Cancer

KEY POINTS

Thyroid cancer is a disease in which malignant (cancer) cells form in the tissues of the thyroid gland.
Thyroid nodules may be adenomas or carcinomas.
Thyroid nodules may be found during a routine medical exam and are usually not cancer.
Being exposed to radiation or having certain genetic syndromes can affect the risk of thyroid cancer.
Medullary thyroid cancer is sometimes caused by a change in a gene that is passed from parent to child.
Signs of thyroid cancer include a swelling or lump in the neck.
Tests that examine the thyroid, neck, and blood are used to detect (find) and diagnose thyroid cancer.
Certain factors affect prognosis (chance of recovery).

Thyroid cancer is a disease in which malignant (cancer) cells form in the tissues of the thyroid gland.

The thyroid is a gland at the base of the throat near the trachea (windpipe). It is shaped like a butterfly, with a right lobe and a left lobe. The isthmus is a thin piece of tissue that connects the two lobes. It usually cannot be felt through the skin.

Anatomy of the thyroid and parathyroid glands; drawing shows the thyroid gland at the base of the throat near the trachea. An inset shows the front and back views. The front view shows that the thyroid is shaped like a butterfly, with the right lobe and left lobe connected by a thin piece of tissue called the isthmus. The back view shows the four pea-sized parathyroid glands. The larynx is also shown. — Anatomy of the thyroid and parathyroid glands. The thyroid gland lies at the base of the throat near the trachea. It is shaped like a butterfly, with the right lobe and left lobe connected by a thin piece of tissue called the isthmus. The parathyroid glands are four pea-sized organs found in the neck near the thyroid. The thyroid and parathyroid glands make hormones.

The thyroid uses iodine, a mineral found in some foods and in iodized salt, to help make several hormones. Thyroid hormones do the following:

Control heart rate, body temperature, and how quickly food is changed into energy (metabolism).
Control the amount of calcium in the blood.

Thyroid nodules may be adenomas or carcinomas.

There are two types of thyroid nodules:

Adenomas: Adenomas can grow very large and sometimes make hormones. Adenomas are not cancer but may rarely become malignant (cancer) and spread to the lungs or lymph nodes in the neck.
Carcinomas: There are three main types of thyroid carcinoma in children:
- Papillary. Papillary thyroid carcinoma is the most common type of thyroid cancerin 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 may have spread to other parts of the body at the time of diagnosis. It is often inherited. The prognosis depends on the size of the tumor at the time of diagnosis.

Papillary and follicular thyroid cancer are sometimes called differentiated thyroid cancer. Medullary and anaplastic thyroid cancer are sometimes called poorly differentiated or undifferentiated thyroid cancer. Anaplastic thyroid cancer is very rare in children and not discussed in this summary.

Thyroid nodules may be found during a routine medical exam and are usually not cancer.

Your child’s doctor may find a lump (nodule) in your child's thyroid during a routine medical exam. A thyroid nodule is an abnormal growth of thyroid cells in the thyroid. Nodules may be solid or fluid -filled.

When a thyroid nodule is found, an ultrasound of the thyroid and a fine-needle aspiration biopsy are often done to check for signs of cancer. Blood tests to check thyroid hormone levels and for anti-thyroid antibodies in the blood may also be done. This is to check for other types of thyroid disease.

Thyroid nodules usually don't cause symptoms or need treatment. Sometimes the thyroid nodules become large enough that it is hard to swallow or breathe and more tests and treatment are needed. Only one in five thyroid nodules become cancer.

Being exposed to radiation or having certain genetic syndromes can affect the risk of thyroid cancer.

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think your child may be at risk.

Risk factors for childhood thyroid cancer include the following:

Being exposed to radiation, such as radiation treatment to the neck or atomic bomb radiation.
Having certain genetic syndromes, such as the following:
- 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.
- Werner syndrome.

Medullary thyroid cancer is sometimes caused by a change in a gene that is passed from parent to child.

The genes in cells carry hereditary information from parent to child. A certain change in the RET gene that is passed from parent to child (inherited) may cause medullary thyroid cancer.

There is a genetic test that is used to check for the changed gene. The patient is tested first to see if he or she has the changed gene. If the patient has it, other family members may also be tested to find out if they have an increased risk of medullary thyroid cancer. Family members, including young children, who have the changed gene may have a thyroidectomy (surgery to remove the thyroid). This can decrease the chance of developing medullary thyroid cancer.

Signs of thyroid cancer include a swelling or lump in the neck.

Sometimes thyroid tumors do not cause any signs or symptoms. These and other signs and symptoms may be caused by thyroid cancer or by other conditions.

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).

Tests that examine the thyroid, neck, and blood are used to detect (find) and diagnose thyroid cancer.

The following tests and procedures may be used:

Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps (nodules) or swelling in the neck, voice box, and lymph nodes, and anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
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 calcitonin (a hormone made by the thyroid that decreases the amount of calcium in the blood).
Thyroglobulin test: The blood is checked for the amount of thyroglobulin, a proteinmade by the thyroid gland. Thyroglobulin levels are low or absent with normal thyroid function but may be higher with thyroid cancer or other conditions.
RET gene test: A laboratory test in which a sample of blood or tissue is tested for a change in the RET gene. This test is done for children who may have medullary thyroid cancer.
Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs in the neck 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 nodule and whether it is solid or a fluid-filled cyst. Ultrasound may be used to guide a fine-needle aspiration biopsy. A complete ultrasound exam of the neck is done before surgery.
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the neck, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
ENLARGE
Computed tomography (CT) scan of the head and neck. The child lies on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the head and neck.
Fine-needle aspiration biopsy of the thyroid: The removal of thyroid tissue using a thin needle. The needle is inserted through the skin into the thyroid. Several tissue samples are removed from different parts of the thyroid. A pathologist views the tissue samples under a microscope to look for cancer cells. Because the type of thyroid cancer can be hard to diagnose, patients should ask to have biopsy samples checked by a pathologist who has experience diagnosing thyroid cancer.
Surgical biopsy: The removal of the thyroid nodule or one lobe of the thyroid during surgery so the cells and tissues can be viewed under a microscope by a pathologist to check for signs of cancer. Because the type of thyroid cancer can be hard to diagnose, patients should ask to have biopsy samples checked by a pathologist who has experience diagnosing thyroid cancer.

Certain factors affect prognosis (chance of recovery).

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

The age of the patient at the time of diagnosis.
The type of thyroid cancer.
The size of the tumor.
Whether the tumor has spread to lymph nodes or other parts of the body at the time of diagnosis.
The patient's general health.

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Stages of Thyroid Cancer