Thyroid nodules and cancer in children
- Stephen LaFranchi, MD
Stephen LaFranchi, MD
- Professor of Pediatrics
- Oregon Health & Sciences University
- Section Editors
- Douglas S Ross, MD
Douglas S Ross, MD
- Section Editor — Thyroid Disease
- Professor of Medicine
- Harvard Medical School
- Mitchell Geffner, MD
Mitchell Geffner, MD
- Section Editor — Pediatric Endocrinology
- Professor of Pediatrics
- Keck School of Medicine, University of Southern California
About 2 percent of children have palpable thyroid nodules. Most of these are benign, including inflammatory lesions or follicular adenomas, but a few are malignant.
The thyroid gland in children is particularly susceptible to irradiation and carcinogenesis. This may be one reason that children with thyroid cancer tend to present with advanced disease. As compared with adults, children with thyroid cancer display a greater frequency of lymph node metastases and distant metastases at the time of diagnosis and higher rates of recurrence during the first decade after diagnosis. Despite these characteristics, children with thyroid cancer generally have a good prognosis.
The evaluation of a child presenting with a thyroid nodule, and an overview of the treatment of thyroid carcinoma is discussed in this topic review. Congenital and acquired goiter and thyroid cysts are discussed separately. (See "Congenital and acquired goiter in children".)
In a study conducted in the southwestern United States, thyroid nodules detectable by palpation were present in 1.8 percent of school children between the ages of 11 and 18 years . In a follow-up study 20 years later, nodules were present in only 0.45 percent of the same subjects, showing that nodules disappeared in 75 percent of subjects . In a group of children without suspected thyroid disease who underwent contrast-enhanced computed tomography (CT) of the chest, thyroid nodules were detected in 1.4 percent, which is much lower than the rate of unsuspected thyroid nodules detected on CT in adults .
Most thyroid nodules in children are benign, but the percentage of nodules harboring cancer in children is probably higher than the commonly quoted figure of 5 percent in adults. Estimates of the rate of malignancy in published case series vary widely, ranging from 10 to 50 percent [4,5]. However, it may be that the 10 to 50 percent rate of cancer in childhood nodules reported in the past is higher than would be found in more recent series, particularly in "incidentally discovered" nodules. Indeed, malignancy was discovered in 5.7 percent of the nodules incidentally detected by contrast-enhanced CT in the study cited above, which is similar to the reported malignancy rate for thyroid nodules in adults, and substantially lower than the previously reported malignancy rates for children . The following calculations also would support a lower estimate of the malignancy rate in children: The Surveillance, Epidemiology and End Results (SEER) registry from 1973 through 2004 reported a total of 1753 pediatric patients with thyroid cancer, with an annual incidence of 0.54 cases per 100,000 population . An annual incidence of 0.54 per 100,000 is equivalent to a prevalence of 10 per 100,000 children aged 1 to 18 years. If 1.8 per 100 children have solitary nodules, but only 10 per 100,000 children develop cancer, approximately only 1 in 180 solitary nodules represents thyroid cancer (0.5 percent). Thus, the higher percentages noted above likely represent "referral bias" of children with increased risk factors for thyroid cancer .
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- CLINICAL PRESENTATION
- Thyroid function tests
- Thyroid scintigraphy
- Neck ultrasound
- Fine-needle aspiration
- Genetic testing
- Benign thyroid nodules
- Differentiated thyroid cancer (DTC)
- Medullary thyroid carcinoma
- SUMMARY AND RECOMMENDATIONS