Thyroid Nodules, Masses and Cancers

What are thyroid nodules or masses?

Thyroid nodules are usually collections of fluid or extra lumps of cells that occur on the thyroid gland. In many cases, nodules and masses are nothing to worry about. However, several risk factors are associated with the development of thyroid nodules in children, including iodine deficiency, prior radiation exposure, a history of thyroid disease and several genetic syndromes. Thyroid nodules are less common among children than adults, but they are more likely to be cancerous in children. Therefore, we evaluate and treat all children with thyroid nodules in a comprehensive and detailed way.

What is thyroid cancer?

Thyroid cancer occurs when an abnormal nodule or mass begins to spread throughout the thyroid or other parts of the body such as the neck and lungs. Symptoms might include a lump in the neck that can be seen or felt, swollen lymph nodes, or hoarseness. Because these symptoms can be evidence of many other conditions, diagnosis by a medical professional is key.

What are the causes of thyroid cancer?

The underlying conditions that can cause thyroid cancer vary widely, but the Children’s Thyroid Center has the expertise to identify the cause and, when possible, treat it.

Some thyroid cancers are the results of genetic conditions that often result in tumors in other parts of the body, as well. This includes DICER1 syndrome, familial adenomatous polyposis, multiple endocrine neoplasia type 2 and PTEN hamartoma tumor syndrome.

Though there is a genetic component to many forms of thyroid cancer, researchers have yet to identify a precise cause. A family history of thyroid cancer, exposure to radiation and other autoimmune thyroid conditions can predispose some children to thyroid nodules and thyroid cancer.

How do we diagnose thyroid cancer?

The Children’s Thyroid Center has the most advanced diagnostic tools and medical professionals with the experience and expertise to accurately diagnose your child. A physical exam, ultrasound and needle biopsy are usually the first steps in evaluating whether a thyroid nodule is at risk of being a thyroid cancer. Sometimes, molecular testing is used for further analysis. Patients might also undergo blood tests to measure the hormone levels in their blood. At the Children’s Thyroid Center, we use the most up-to-date diagnostic tests. Patients might have a CT scan or other imaging of the thyroid and chest, or they may undergo a special camera exam of the voice box to evaluate the nerves surrounding the thyroid. The results of these procedures are discussed in person at our Thyroid Tumor Board’s meetings. In these meetings, pediatric specialists and adult consultants from endocrinology, surgery, oncology, nuclear medicine, radiology, genetics and pathology collaboratively review a patient's results to determine the best treatment plan. Through this multidisciplinary approach, patients have access to a diverse team of experts instead of relying on a single opinion. 

How do we treat thyroid cancer?

In most cases, surgery is the best treatment for thyroid cancer. The Children’s Thyroid Center provides comprehensive surgical management for thyroid cancer, and we use state-of-the-art technologies like nerve monitoring and real-time ultrasound to make the surgery as safe as possible. In some cases, treatment will involve the full removal of the thyroid. In others, only part of the thyroid is removed. All surgical plans are reviewed by both of the center’s surgical co-directors, Gary Hartman, MD, and Kara Meister, MD, to ensure close attention to every detail. Sometimes, treatment may involve radioactive iodine therapy. Helen Nadel, MD, an integral member of the Children’s Thyroid Center, is an international expert in pediatric nuclear medicine.

Who is most susceptible to thyroid cancer?

Children with a family history of thyroid cancer or a personal history of cancer are at a higher risk for thyroid cancer, as are children with an autoimmune thyroid disease. The greatest risk for childhood thyroid cancer is among adolescent girls, especially those of Hispanic descent. However, it occurs in all ages, races, and genders of children. Thyroid cancer in children is on the rise in certain populations.

Your child is diagnosed with thyroid cancer—what next?

First, remember that thyroid cancer is a very treatable disease. Children with the most common types of thyroid cancer have an excellent long-term survival rate. For the best care and support services, seek care from a center associated with the Children’s Oncology Group (COG), a network of 9,000 experts worldwide, including Stanford Children’s Thyroid Center.