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By Andrew J. Bauer, M.D. and Gary L. Francis, M.D., Ph.D., Reprinted, with permission, from pages 48-49 of Chapter 5 of the book "Thyroid Cancer: A Guide for Patients", (Douglas Van Nostrand, M.D., Gary Bloom, and Leonard Wartofsky, M.D., editors, Keystone Press, 2004.) See http://www.thyca.org/TCGuide.htm.

As suggested above, the answer to this is yes. In fact, some of the differences in clinical findings between thyroid cancers in children versus thyroid cancers in adults may make it easier for you to understand the evaluation and treatment that we would recommend for your child or teen. As mentioned at the outset of this discussion, while the majority of thyroid nodules are not cancer, there is an increased risk that nodules in children, as compared to adults, are cancerous. Because of this, there is a greater need to more thoroughly and more quickly evaluate these when they are found. Unfortunately, there is no blood test of X-ray test that allows us to distinguish which nodule will be cancerous and which will not.

Unlike adults, more than half the children with thyroid cancer have swollen glands (enlarged lymph nodes in the neck that can be felt on exam). These lymph nodes are usually swollen because of small amounts of cancer that have spread to them, and while this finding predicts a worse outcome in adults, it does not predict a worse outcome in children. In fact, thyroid cancer should be considered in any child that presents with persistent enlargement of the neck lymph nodes.

In addition to lymph node involvement, almost 15 percent of children have cancer that has already spread to the lungs (pulmonary metastasis). In adults, this is associated with a significantly worse outcome. In children this does not appear to be the case. Many children will continue to have persistent disease; however, it often does not increase or worsen over 15 to 20 years, and in fact, over the same time period, some of these children's diseases may decrease to the point of being undetectable.

One of our greatest limitations in treating children with thyroid cancer is the relative lack of information concerning long-term outcome. Overall, we are fortunate that thyroid cancer in children is uncommon. However, because of the relative rarity compared to adults, we lack good data on a large collection of pediatric patients who have been followed over their lifetime. With these limitations in our knowledge in mind, the following is a discussion of our approach to the evaluation of thyroid nodule, and our treatment recommendations.

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