Signs & symptoms of thyroid cancer
Often there’s no obvious sign a child has thyroid cancer. The problem is detected when a doctor feels an abnormality in the neck during a physical exam or when the child has an imaging scan for another issue.
The most common symptoms to appear include:
- Breathing or swallowing difficulties
- A lump in the neck
- Persistently swollen lymph glands in the neck
- Hoarseness or a change in the voice
Diagnosis of thyroid cancer
Multiple tests are generally required to diagnose thyroid cancer. The doctor will start with a physical exam and a discussion of your child’s medical history and symptoms.
To confirm thyroid cancer or rule out other conditions, the doctor may recommend one or more of the following:
- Blood tests. Blood samples are drawn to run a thyroid function test, which checks levels of thyroid-stimulating hormone, and to measure levels of thyroglobulin and calcitonin. Abnormal results can indicate a thyroid issue, such as cancer.
- Genetic testing. A DNA analysis (using a blood, saliva or tissue sample) can identify the gene mutations or genetic conditions that increase thyroid cancer risk.
- Thyroid ultrasound. This painless imaging test uses sound waves to generate pictures of the thyroid. It can help doctors determine whether a suspicious nodule is a solid tumor or a liquid-filled cyst.
- Computed tomography (CT) scan. A computer linked to an X-ray machine creates detailed images of the neck and chest, which help doctors decide whether surgery is necessary.
- Thyroid scan. For this targeted imaging test, the patient swallows a capsule containing a tiny amount of radioactive iodine, which collects in the thyroid gland (cells in the thyroid naturally take up iodine because they use it to make hormones). Special imaging equipment detects the radioactive material and provides a clear view of the thyroid. The images can show whether cancer has spread beyond the gland.
- Biopsy. This involves removing a small amount of tissue from the suspected tumor and then examining the cells under a microscope to determine whether the lump is cancerous. A thyroid biopsy can be done in two ways. In a fine needle aspiration, the doctor inserts a thin needle into the thyroid to remove some cells. This procedure can be done on an outpatient basis (that is, with no overnight stay) using only local anesthesia to numb the area. The second biopsy approach is to take a tissue sample during the surgery to remove the tumor.
Treatment of thyroid cancer
Treatment almost always starts with surgery to remove as much of the cancer as possible. Depending on your child’s medical history, the tumor's size and how much it has spread, as well as other factors, the surgeon may remove part of the thyroid (partial thyroidectomy) or the entire gland (total thyroidectomy). Most children will undergo total removal.
If there’s a suspicion that the cancer has spread to lymph nodes in the neck, the surgeon may remove them as well. A pathologist then evaluates the tumor and lymph nodes to determine the type and stage of the cancer. This information helps doctors decide whether additional treatment is needed.
Children who undergo total thyroidectomy will have to take thyroid replacement medication for the rest of their lives. These synthetic thyroid hormones have the same effects in the body as the hormones naturally produced by the thyroid.
Additional thyroid cancer treatments
Some children need treatments in addition to or other than surgery. Possibilities include:
- Radioactive iodine (RAI) therapy. This technique delivers radiation directly to any cancer cells remaining after surgery or to a tumor that can’t be surgically removed. Once RAI is taken into the body (usually orally), the substance collects in thyroid tissue. The radiation destroys any remaining thyroid tissue as well as any cancerous thyroid cells that have spread to other places in the body. Because thyroid cells absorb most of the RAI, the radiation does minimal harm to other healthy tissues.
- Targeted therapy. Various drugs are used to block the actions of specific proteins inside cancer cells, such as enzymes that make them multiply and spread. This approach may be used for patients whose cancer doesn’t respond to RAI therapy and for children with medullary thyroid cancer linked to an inherited gene mutation.
This information is for educational purposes only and is not intended to replace the advice of your child's doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your child's provider.
