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Pediatric Thyroid Cancer Treatment & Management

  • Author: Mark E Gerber, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
Updated: Apr 30, 2015

Medical Care

Radioactive therapy with iodine 131 (131 I) is indicated to ablate residual normal thyroid and to treat functioning metastases in differentiated thyroid tumors. Because pediatric patients are few and the prognosis is generally excellent, 131I is usually recommended only for patients with extensive unresectable cervical nodal involvement, invasion of vital structures, or distant metastases. Very few instances of solid tumors or leukemia associated with 131I treatment have been reported.[56]


Surgical Care

See the list below:

  • Treatment for thyroid malignancy is primarily surgical. Because of the unusual combination of an excellent prognosis and an advanced-stage disease presentation, the initial extent of surgery is controversial. Some recommend that the initial surgical approach should be conservative, while others advocate aggressive management with total thyroidectomy and radioactive iodine (RAI) for all patients. The relative infrequency of thyroid malignancy makes this controversy difficult to resolve.
  • Thyroid lobectomy is the initial procedure of choice for most solitary thyroid lesions. This procedure adequately removes the pathologic region but spares enough thyroid tissue to maintain a euthyroid state.[57] The thyroid lobule should be sent immediately for frozen section. If the frozen section confirms carcinoma, total or subtotal thyroidectomy can be completed. If the initial frozen section is indeterminate, one should wait for the final report. If the final pathology finding reveals carcinoma, then a total or subtotal thyroidectomy can be performed at a later date.
  • The need for total versus near-total or subtotal thyroidectomy is controversial. Proponents for near-total or subtotal thyroidectomy believe that these procedures decrease the incidence of complications such as recurrent nerve injury and parathyroid devascularization, although the need to identify and preserve these structures remains.[58] A near-total thyroidectomy with radical lobectomy on the side of the primary lesion and subtotal removal of the contralateral lobe is recommended if the lesion is proven to be or suggestive of carcinoma.[12]
  • Although total thyroidectomy has not been proven to decrease recurrence, supporters of this method argue that remaining thyroid tissue may interfere with the use of radioactive iodine (RAI) in the postoperative diagnostic scanning and in the treatment of microscopic regional and distant disease.
  • Residual thyroid tissue also provides a source of thyroglobulin that may postoperatively diminish the specificity of the test as a tumor marker.[24]

Medullary carcinoma

See the list below:

  • Total thyroidectomy and central neck dissection are indicated for biopsy-proven medullary carcinoma. Prophylactic total thyroidectomy may be indicated in children with a family history of multiple endocrine neoplasia (MEN) syndrome. Genetic screening is now possible for the MEN2 gene, and prophylactic surgery may be performed in patients as young as 5 years to prevent the occurrence of C-cell hyperplasia or carcinoma.[59]

Neck dissection

See the list below:

  • Selective ipsilateral neck dissection in pediatric thyroid surgery is indicated for proven or suspected regional lymph node metastasis. During the dissection, lymph nodes in the paratracheal region, tracheoesophageal groove, and lateral areas can be inspected. Suspicious nodes are excised.[12]
  • Formal neck dissection has not been shown to improve outcome and has an increased risk of minor surgical complications.[25, 60]
  • The authors advocate the use of total thyroidectomy with selective neck dissection for the treatment of pathologically confirmed thyroid carcinoma.
Contributor Information and Disclosures

Mark E Gerber, MD Clinical Associate Professor of Surgery, University of Chicago Pritzker School of Medicine; Division Head, Otolaryngology-Head and Neck Surgery; Director, Pediatric Otolaryngology-Head and Neck Surgery, NorthShore University Health System

Mark E Gerber, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Bronchoesophagological Association, American Society of Pediatric Otolaryngology, Society for Ear, Nose and Throat Advances in Children, American Academy of Pediatrics, American Rhinologic Society

Disclosure: Nothing to disclose.


Brian Kip Reilly, MD Assistant Professor of Otolaryngology and Pediatrics, Department of Otolaryngology, Children's National Medical Center, George Washington University School of Medicine

Brian Kip Reilly, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Mihir K Bhayani, MD Clinical Assistant Professor, Department of Surgery, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine; Consulting Surgeon, Head and Neck Surgical Oncology Section, Department of Otolaryngology, NorthShore University Health System

Mihir K Bhayani, MD is a member of the following medical societies: American Head and Neck Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Nader Sadeghi, MD, FRCSC Professor, Otolaryngology-Head and Neck Surgery, Director of Head and Neck Surgery, George Washington University School of Medicine and Health Sciences

Nader Sadeghi, MD, FRCSC is a member of the following medical societies: American Head and Neck Society, American Thyroid Association, American Academy of Otolaryngology-Head and Neck Surgery, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.


Russell A Faust, MD, PhD Consulting Staff, Department of Otolaryngology, Columbus Children's Hospital

Disclosure: Nothing to disclose.

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A monomorphous cell population of Hürthle cells arranged in loosely cohesive clusters and single cells. The cells are polyhedral and have abundant granular cytoplasm with well-defined cell borders. The nuclei are enlarged and have a central prominent macronucleolus.
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