eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Head & Neck Surgery

Thyroid Cancer in Children: Treatment & Medication

Author: Mark E Gerber, MD, Assistant Professor, Section Head, Pediatric Otolaryngology-Head and Neck Surgery, Evanston Northwestern Healthcare
Coauthor(s): Brian Reilly, MD, Staff Physician, Department of Otolaryngology, McGaw Medical Center of Northwestern University
Contributor Information and Disclosures

Updated: Sep 26, 2008

Treatment

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.53

Surgical Care

  • 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.54 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.55 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.10
  • 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.21

Medullary carcinoma

  • 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.56

Neck dissection

  • 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.10
  • Formal neck dissection has not been shown to improve outcome and has an increased risk of minor surgical complications.22,57
  • The authors advocate the use of total thyroidectomy with selective neck dissection for the treatment of pathologically confirmed thyroid carcinoma.

Medication

Postoperative suppression of TSH with thyroid hormone may decrease recurrence and is more effective in papillary and papillary-follicular carcinomas.

More on Thyroid Cancer in Children

Overview: Thyroid Cancer in Children
Differential Diagnoses & Workup: Thyroid Cancer in Children
Treatment & Medication: Thyroid Cancer in Children
Follow-up: Thyroid Cancer in Children
References
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References

  1. Albright JT, Topham AK, Reilly JS. Pediatric head and neck malignancies: US incidence and trends over 2 decades. Arch Otolaryngol Head Neck Surg. Jun 2002;128(6):655-9. [Medline].

  2. Silverman SH, Nussbaum M, Rausen AR. Thyroid nodules in children: a ten year experience at one institution. Mt Sinai J Med. Sep-Oct 1979;46(5):460-3. [Medline].

  3. Ridgway EC. Clinician Evaluation of a Solitary Thyroid Nodules. Journal of Clinical Endocrinology and Metaoblism. 1992;Vol. 74, No. 2:231-235.

  4. Niedziela M, Korman E. Thyroid carcinoma in a fourteen-year-old boy with Graves disease. Med Pediatr Oncol. Apr 2002;38(4):290-1. [Medline].

  5. Halac I, Zimmerman D. Thyroid nodules and cancers in children. Endocrinol Metab Clin North Am. Sep 2005;34(3):725-44, x. [Medline].

  6. Festen C, Otten BJ, van de Kaa CA. Follicular adenoma of the thyroid gland in children. Eur J Pediatr Surg. Oct 1995;5(5):262-4. [Medline].

  7. Schneider K. Sonographic imaging of the thyroid in children. Prog Pediatr Surg. 1991;26:1-14. [Medline].

  8. Sherman NH, Rosenberg HK, Heyman S, et al. Ultrasound evaluation of neck masses in children. J Ultrasound Med. Mar 1985;4(3):127-34. [Medline].

  9. Joppich I, Roher HD, Hecker WC, et al. Thyroid carcinoma in childhood. Prog Pediatr Surg. 1983;16:23-8. [Medline].

  10. Garcia CJ, Daneman A, Thorner P, et al. Sonography of multinodular thyroid gland in children and adolescents. Am J Dis Child. Jul 1992;146(7):811-6. [Medline].

  11. Chaukar DA, Rangarajan V, Nair N, et al. Pediatric thyroid cancer. J Surg Oncol. Nov 1 2005;92(2):130-3. [Medline].

  12. Khurana KK, Labrador E, Izquierdo R, et al. The role of fine-needle aspiration biopsy in the management of thyroid nodules in children, adolescents, and young adults: a multi-institutional study. Thyroid. Apr 1999;9(4):383-6. [Medline].

  13. Lugo-Vicente H, Ortiz VN, Irizarry H, et al. Pediatric thyroid nodules: management in the era of fine needle aspiration. J Pediatr Surg. Aug 1998;33(8):1302-5. [Medline].

  14. Niedziela M. Pathogenesis, diagnosis and management of thyroid nodules in children. Endocr Relat Cancer. Jun 2006;13(2):427-53. [Medline].

  15. Corrias A, Cassio A, Weber G, et al. Thyroid nodules and cancer in children and adolescents affected by autoimmune thyroiditis. Arch Pediatr Adolesc Med. Jun 2008;162(6):526-31. [Medline].

  16. Miccoli P, Minuto MN, Ugolini C, et al. Papillary thyroid cancer: pathological parameters as prognostic factors in different classes of age. Otolaryngol Head Neck Surg. Feb 2008;138(2):200-3. [Medline].

  17. Williams ED, Abrosimov A, Bogdanova T, et al. Thyroid carcinoma after Chernobyl latent period, morphology and aggressiveness. Br J Cancer. Jun 1 2004;90(11):2219-24. [Medline].

  18. Ron E. Thyroid cancer incidence among people living in areas contaminated by radiation from the Chernobyl accident. Health Phys. Nov 2007;93(5):502-11. [Medline].

  19. Yoskovitch A, Laberge JM, Rodd C, et al. Cystic thyroid lesions in children. J Pediatr Surg. Jun 1998;33(6):866-70. [Medline].

  20. Alessandri AJ, Goddard KJ, Blair GK, et al. Age is the major determinant of recurrence in pediatric differentiated thyroid carcinoma. Med Pediatr Oncol. Jul 2000;35(1):41-6. [Medline].

  21. La Quaglia MP, Telander RL. Differentiated and medullary thyroid cancer in childhood and adolescence. Semin Pediatr Surg. Feb 1997;6(1):42-9. [Medline].

  22. Attie JA. Carcinoma of the thyroid in children and adolescents. In: F Lifshitz. Pediatric Endocrinology. 3. New York: Marcel Dekker; 1996:423–432.

  23. Estevao-Costa J, Gil-Da-Costa MJ, Medina AM, et al. Thyroid carcinoma in a newborn: clinical challenges in managing the first recorded case. Med Pediatr Oncol. Apr 2000;34(4):290-2. [Medline].

  24. Yip FW, Reeve TS, Poole AG, et al. Thyroid nodules in childhood and adolescence. Aust N Z J Surg. Oct 1994;64(10):676-8. [Medline].

  25. Skinner MA, Wells SA Jr. Medullary carcinoma of the thyroid gland and the MEN 2 syndromes. Semin Pediatr Surg. Aug 1997;6(3):134-40. [Medline].

  26. Cotterill SJ, Pearce MS, Parker L. Thyroid cancer in children and young adults in the North of England. Is increasing incidence related to the Chernobyl accident?. Eur J Cancer. May 2001;37(8):1020-6. [Medline].

  27. Gawrysiak W, Niedziela M. Suppurative thyroiditis. Endokrynologia Pediatryczna (Pediatric Endocrinology). 2005;4:65-69.

  28. Bhatia S, Ramsay NK, Bantle JP, et al. Thyroid Abnormalities after Therapy for Hodgkin's Disease in Childhood. Oncologist. 1996;1(1 & 2):62-67. [Medline].

  29. Jensen MO, Antonenko D. Thyroid and thymic malignancy following childhood irradiation. J Surg Oncol. Jul 1992;50(3):206-8. [Medline].

  30. Metayer C, Lynch CF, Clarke EA, et al. Second cancers among long-term survivors of Hodgkin's disease diagnosed in childhood and adolescence. J Clin Oncol. Jun 2000;18(12):2435-43. [Medline].

  31. Nikiforov Y, Gnepp DR. Pediatric thyroid cancer after the Chernobyl disaster. Pathomorphologic study of 84 cases (1991-1992) from the Republic of Belarus. Cancer. Jul 15 1994;74(2):748-66. [Medline].

  32. Vane D, King DR, Boles ET Jr. Secondary thyroid neoplasms in pediatric cancer patients: increased risk with improved survival. J Pediatr Surg. Dec 1984;19(6):855-60. [Medline].

  33. Thomas GA, Bunnell H, Cook HA, et al. High prevalence of RET/PTC rearrangements in Ukrainian and Belarussian post-Chernobyl thyroid papillary carcinomas: a strong correlation between RET/PTC3 and the solid-follicular variant. J Clin Endocrinol Metab. Nov 1999;84(11):4232-8. [Medline].

  34. Sklar C, Whitton J, Mertens A, et al. Abnormalities of the thyroid in survivors of Hodgkin's disease: data from the Childhood Cancer Survivor Study. J Clin Endocrinol Metab. Sep 2000;85(9):3227-32. [Medline].

  35. Patti G, Ragni G, Calisti A. Papillary thyroid carcinoma in a thyroglossal duct cyst in a child. Med Pediatr Oncol. Jan 2000;34(1):67-9. [Medline].

  36. Luboshitzky R, Lavi I, Ishay A. Serum thyroglobulin levels after fine-needle aspiration of thyroid nodules. Endocr Pract. May-Jun 2006;12(3):264-9. [Medline].

  37. Bockhorn M, Frilling A, Rewerk S, et al. Lack of elevated serum carcinoembryonic antigen and calcitonin in medullary thyroid carcinoma. Thyroid. Jun 2004;14(6):468-70. [Medline].

  38. Telander RL, Moir CR. Medullary thyroid carcinoma in children. Semin Pediatr Surg. Aug 1994;3(3):188-93. [Medline].

  39. Bajpai M, Ramaswamy S, Gupta DK, et al. Solitary thyroid nodule. Indian Pediatr. Jan 1992;29(1):116-8. [Medline].

  40. Solbiati L, Cioffi V, Ballarati E. Ultrasonography of the neck. Radiol Clin North Am. Sep 1992;30(5):941-54. [Medline].

  41. Hegedüs L, Bonnema SJ, Bennedbaek FN. Management of simple nodular goiter: current status and future perspectives. Endocr Rev. Feb 2003;24(1):102-32. [Medline].

  42. Harach HR, Sanchez SS, Williams ED. Pathology of the autonomously functioning (hot) thyroid nodule. Ann Diagn Pathol. Feb 2002;6(1):10-9. [Medline].

  43. Croom RD 3rd, Thomas CG Jr, Reddick RL, et al. Autonomously functioning thyroid nodules in childhood and adolescence. Surgery. Dec 1987;102(6):1101-8. [Medline].

  44. Geiger JD, Thompson NW. Thyroid tumors in children. Otolaryngol Clin North Am. Aug 1996;29(4):711-9. [Medline].

  45. Desjardins JG, Khan AH, Montupet P, et al. Management of thyroid nodules in children: a 20-year experience. J Pediatr Surg. Aug 1987;22(8):736-9. [Medline].

  46. Eisenhut CC, King DE, Nelson WA, et al. Fine-needle biopsy of pediatric lesions: a three-year study in an outpatient biopsy clinic. Diagn Cytopathol. Feb 1996;14(1):43-50. [Medline].

  47. Raab SS, Silverman JF, Elsheikh TM, et al. Pediatric thyroid nodules: disease demographics and clinical management as determined by fine needle aspiration biopsy. Pediatrics. Jan 1995;95(1):46-9. [Medline].

  48. Bettendorf M. Thyroid disorders in children from birth to adolescence. Eur J Nucl Med Mol Imaging. Aug 2002;29 Suppl 2:S439-46. [Medline].

  49. Gimm O, Sutter T, Dralle H. Diagnosis and therapy of sporadic and familial medullary thyroid carcinoma. J Cancer Res Clin Oncol. 2001;127(3):156-65. [Medline].

  50. Dinauer CA, Breuer C, Rivkees SA. Differentiated thyroid cancer in children: diagnosis and management. Curr Opin Oncol. Jan 2008;20(1):59-65. [Medline].

  51. AJCC Cancer Staging Manual. Sixth Edition. New York: Springer-Verlag, , Inc; (2002).

  52. Yeh SD, La Quaglia MP. 131I therapy for pediatric thyroid cancer. Semin Pediatr Surg. Aug 1997;6(3):128-33. [Medline].

  53. Bryarly RC, Shockley WW, Stucker FJ. The method and management of thyroid surgery in the pediatric patient. Laryngoscope. Sep 1985;95(9 Pt 1):1025-8. [Medline].

  54. Herzog B. Thyroid gland diseases and tumours. Surgical aspects. Prog Pediatr Surg. 1983;16:15-22. [Medline].

  55. Lallier M, St-Vil D, Giroux M, et al. Prophylactic thyroidectomy for medullary thyroid carcinoma in gene carriers of MEN2 syndrome. J Pediatr Surg. Jun 1998;33(6):846-8. [Medline].

  56. Newman KD, Black T, Heller G, et al. Differentiated thyroid cancer: determinants of disease progression in patients <21 years of age at diagnosis: a report from the Surgical Discipline Committee of the Children's Cancer Group. Ann Surg. Apr 1998;227(4):533-41. [Medline].

  57. Ben Arush MW, Stein ME, Perez Nahum M, et al. Pediatric thyroid carcinoma: 22 years of experience at the Northern Israel Oncology Center (1973-1995). Pediatr Hematol Oncol. Jan-Feb 2000;17(1):85-92. [Medline].

  58. Amrikachi M, Ponder TB, Wheeler TM, et al. Thyroid fine-needle aspiration biopsy in children and adolescents: experience with 218 aspirates. Diagn Cytopathol. Apr 2005;32(4):189-92. [Medline].

  59. Belfiore A, Giuffrida D, La Rosa GL, et al. High frequency of cancer in cold thyroid nodules occurring at young age. Acta Endocrinol (Copenh). Aug 1989;121(2):197-202. [Medline].

  60. Hughes CJ, Shaha AR, Shah JP, et al. Impact of lymph node metastasis in differentiated carcinoma of the thyroid: a matched-pair analysis. Head Neck. Mar-Apr 1996;18(2):127-32. [Medline].

  61. Millman B, Pellitteri PK. Nodular thyroid disease in children and adolescents. Otolaryngol Head Neck Surg. Jun 1997;116(6 Pt 1):604-9. [Medline].

  62. Salas M. Thyroid nodules in children and adolescents. In: Ed. F Lifshitz. In Pediatric Endocrinology, edn 3. New York: Marcel Dekker; 1995:pp 415-422.

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Further Reading

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Keywords

thyroid cancer in children, thyroid, thyroid cancer, pediatric thyroid carcinoma, thyroid nodule, thyroid enlargement, papillary carcinoma, follicular carcinoma, familial medullary thyroid carcinoma, MTC, familial MTC, endocrine disorder, endocrine abnormality, multiple endocrine neoplasia type 2, MEN2, MEN2A, MEN2B, pheochromocytoma, hyperparathyroidism, mucosal neuromas

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Contributor Information and Disclosures

Author

Mark E Gerber, MD, Assistant Professor, Section Head, Pediatric Otolaryngology-Head and Neck Surgery, Evanston Northwestern Healthcare
Mark E Gerber, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Rhinologic Society, Chicago Medical Society, and Illinois State Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Brian Reilly, MD, Staff Physician, Department of Otolaryngology, McGaw Medical Center of Northwestern University
Brian Reilly, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery
Disclosure: Nothing to disclose.

Medical Editor

Russell A Faust, MD, PhD, Consulting Staff, Department of Otolaryngology, Columbus Children's Hospital
Russell A Faust, MD, PhD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Legal Medicine, American Laryngological Rhinological and Otological Society, American Rhinologic Society, American Society for Head and Neck Surgery, and American Society of Law Medicine and Ethics
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Nader Sadeghi, MD, FRCS(C), Associate Professor of Surgery, Director of Head and Neck Surgery, Division of Otolaryngology, George Washington University
Nader Sadeghi, MD, FRCS(C) is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, Federation of Medical Specialists in Quebec, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, 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, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown

 
 
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