What is the thyroid? The thyroid is a butterfly-shaped gland located in the front part of your neck.
Each “wing” of the butterfly is normally about the size of the end of your thumb. The thyroid produces thyroid hormones, thyroxine (T4) and triiodothyronine (T3), which regulate how your body processes energy and keeps you going.
Thyroid nodules are lumps of solid tissue or fluid that develop in the thyroid. It is not clear what causes these nodules, though they are very common. By the time you are 60 years old, you have over a 50% chance of developing such a nodule. With more and better testing, more of these nodules are becoming discovered. Most thyroid nodules are not cancer. Pediatric thyroid cancer indeed is quite rare, with perhaps 5 new cases per 1,000,000 children every year1.
Risk factors for pediatric thyroid cancer include exposure to radiation to the head and neck. After the Chernobyl nuclear reactor explosion in 1986, over 5000 children developed thyroid cancer2. The highest risk is found after radiation treatment for other cancers, such as lymphomas. Typically cancers, if they do develop, are discovered 5-20+ years3 after radiation exposure, and thus it may be helpful to start ultrasound screening for such cancers after 5 years.
Thyroid cancer can be familial, especially when three or more family members develop thyroid cancer. Research is ongoing to discover the responsible genes, but in a family at risk, thyroid ultrasounds every 1-2 years, starting at age 8 years, may be helpful to detect such cancers early. There are certain conditions, typically obvious and easily diagnosed long beforehand, associated with thyroid cancer. These include Cowden’s syndrome, Gardner syndrome, and Werner syndrome.
The best next test is a biopsy of the thyroid nodule. A biopsy is a procedure to remove a small sample of the nodule for examination with a microscope. At the UCLA Mattel Children’s Hospital, we do this biopsy under the guidance of an ultrasound machine. We are one of the very few centers in the United States to offer this level of expertise in the evaluation of children with thyroid nodules. Our pediatric endocrinology providers have performed over 200 of these ultrasound-guided biopsies. A very small needle size will be used, and very often this can be done just with medication to numb the skin, depending on the choice of you and your child. Afterwards, your child can go home and resume your usual activities that same day.
If the results of the biopsy do not look like cancer, then we can continue to follow you to make sure that you are doing well at the UCLA Pediatric Endocrinology Clinic. If the results look like cancer, then your child can be followed by the UCLA Surgical Endocrinology Unit.
Thyroid cancer in childhood is unique because although it has a higher chance of spreading, children with this cancer are likely to live relatively well with this cancer4. After 25 years, the survival rate is over 95%, and thus the vast majority of such children proceed to productive and fulfilling lives and careers. Our expert team includes experienced surgeons who are specially trained in endocrinology surgery, radiologists with the longest-standing radioactive iodine program in the Los Angeles area, and pathologists with extensive experience in reviewing thyroid cancer. Together, we will work for the best care for your child.