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Home > Patient & Family Resources > Health Library > Childhood Thyroid Cancer Treatment (PDQ®): Treatment - Patient Information [NCI]
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This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.
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. 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:
Thyroid nodules may be adenomas or carcinomas.
There are two types of thyroid nodules:
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 is 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 the thyroid during a routine medical exam, or a nodule may be seen on an imaging test or during surgery for another condition. 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 lymph nodes in the neck is done. A fine-needle aspiration biopsy may be 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:
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 papillary or follicular thyroid cancer or by other conditions.
Check with your child's doctor if your child has any of the following:
These and other signs and symptoms may be caused by medullary thyroid cancer or by other conditions.
Tests that examine the thyroid, neck, and blood are used to diagnose and stage thyroid cancer.
Tests are done to diagnose and stage cancer. After cancer is diagnosed, more tests are done to find out if cancer cells have spread to nearby areas or to other parts of the body. This process is called staging. Tests done to find out if cancer cells have spread before the tumor is removed by surgery is called preoperative staging. It is important to know whether cancer has spread in order to plan the best treatment.
The following tests and procedures may be used:
Certain factors affect prognosis (chance of recovery).
The prognosis depends on the following:
After the cancer has been removed by surgery, tests are done to find out if cancer cells remain in the body.
Tests are done after surgery to find out if cancer cells remain and to determine if more treatment is needed. This is called postoperative staging.
The following tests and procedures may be done about 12 weeks after surgery:
There are three ways that cancer spreads in the body.
Cancer can spread through tissue, the lymph system, and the blood:
Cancer may spread from where it began to other parts of the body.
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if thyroid cancer spreads to the lung, the cancer cells in the lung are actually thyroid cancer cells. The disease is metastatic thyroid cancer, not lung cancer.
Sometimes childhood thyroid cancer continues to grow or comes back after treatment.
Progressive thyroid cancer is cancer that continues to grow, spread, or get worse. Progressive disease may be a sign that the cancer has become refractory to treatment.
Recurrent thyroid cancer is cancer that has recurred (come back) after treatment. The cancer may come back in the thyroid or in other parts of the body.
There are different types of treatment for patients with thyroid cancer.
Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.
Children with thyroid cancer should have their treatment planned by a team of doctors who are experts in treating childhood cancer.
Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other pediatric health professionals who are experts in treating children with cancer and who specialize in certain areas of medicine. This may include the following specialists and others:
Four types of standard treatment are used:
Surgery is the most common treatment for thyroid cancer. One of the following procedures may be used:
In children, a total thyroidectomy is usually done.
Radioactive iodine therapy
Follicular and papillary thyroid cancers are sometimes treated with radioactive iodine (RAI) therapy. RAI therapy may be given to children after surgery to kill any thyroid cancer cells that were not removed or to children whose tumor cannot be removed by surgery. RAI is taken by mouth and collects in any remaining thyroid tissue, including thyroid cancer cells that have spread to other places in the body. Because only thyroid tissue takes up iodine, the RAI destroys thyroid tissue and thyroid cancer cells without harming other tissue. Before a full treatment dose of RAI is given, a small test dose is given to see if the tumor takes up the iodine.
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do.
Tyrosine kinase inhibitor therapy (TKI) is a type of targeted therapy that blocks signals needed for tumors to grow. Larotrectinib and entrectinib are TKIs used to treat children with progressive or recurrent papillary and follicular thyroid cancer. Vandetanib is a TKI used to treat children with advanced medullary thyroid cancer. Selpercatinib is a TKI used to treat children with advanced or metastatic thyroid cancer.
Targeted therapy is being studied for the treatment of childhood thyroid cancer that has recurred (come back).
Hormone replacement therapy
Hormones are substances made by glands in the body and circulated in the bloodstream. After treatment for thyroid cancer, the thyroid is not able to make enough thyroid hormone. Patients are given thyroid hormone replacement pills for the rest of their lives.
New types of treatment are being tested in clinical trials.
Information about clinical trials is available from the NCI website.
Treatment for childhood thyroid cancer may cause side effects.
For information about side effects that begin during treatment for cancer, see our Side Effects page.
Side effects from cancer treatment that begin after treatment and continue for months or years are called late effects. Late effects of cancer treatment for childhood thyroid cancer may include:
Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.)
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI's clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
Follow-up tests may be needed.
It is common for thyroid cancer to recur (come back), especially in children younger than 10 years and those with cancer in the lymph nodes. Ultrasound, whole-body scan, and thyroglobulin tests may be done from time to time to check if the cancer has recurred. Lifelong follow-up of thyroid hormone levels in the blood is needed to make sure the right amount of hormone replacement therapy (HRT) is being given. Talk with your child's doctor to find out how often these tests need to be done.
For information about the treatments listed below, see the Treatment Option Overview section.
Treatment of newly diagnosed papillary and follicular thyroid carcinoma in children may include the following:
Within 12 weeks of surgery, tests are done to find out if thyroid cancer remains in the body. These may include thyroglobulin tests and a whole-body thyroid scan. A whole-body thyroid scan is done to find areas in the body where thyroid cancer cells that were not removed during surgery may be dividing quickly. Radioactive iodine is used because only thyroid cells take up iodine. A very small amount of radioactive iodine is swallowed, travels through the blood, and collects in thyroid tissue and thyroid cancer cells anywhere in the body. If thyroid cancer remains, a large dose of radioactive iodine is given to destroy any remaining thyroid cancer cells. A whole-body SPECT (single photon emission computed tomography) scan may be done 4 to 7 days after treatment to check whether all of the cancer cells have been destroyed.
See the PDQ summary on Childhood Multiple Endocrine Neoplasia (MEN) Syndromes Treatment for more information.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Treatment of newly diagnosed medullary thyroid carcinoma in children may include the following:
Treatment of progressive or recurrent papillary and follicular thyroid carcinoma in children may include the following:
Treatment of progressive or recurrent medullary thyroid carcinoma in children may include the following:
For more information from the National Cancer Institute about thyroid cancer, see the following:
For more childhood cancer information and other general cancer resources, see the following:
Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.
PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government's center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.
Purpose of This Summary
This PDQ cancer information summary has current information about the treatment of childhood thyroid cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.
Reviewers and Updates
Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.
The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Pediatric Treatment Editorial Board.
Clinical Trial Information
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Clinical trials can be found online at NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).
Permission to Use This Summary
PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as "NCI's PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary]."
The best way to cite this PDQ summary is:
PDQ® Pediatric Treatment Editorial Board. PDQ Childhood Thyroid Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/thyroid/patient/child-thyroid-treatment-pdq. Accessed <MM/DD/YYYY>.
Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 3,000 scientific images.
The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website's E-mail Us.
Last Revised: 2021-02-18
If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.
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