Pediatric Thyroid Nodules

Pediatric Thyroid Nodules

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Summary

Thyroid nodules are growths or lumps in your thyroid gland. Most thyroid nodules are not cancerous; however, in some children, they are an indication of thyroid cancer. These benign masses are usually soft and compressible and are found during a routine examination.

Causes

The exact cause of thyroid nodules is unknown. Possible contributors may include:

Risk Factors

  • Age (Incidence increases with age)
  • Chemotherapy
  • A family history of thyroid nodules
  • A family history of cancer
  • MEN
  • Previous radiation exposure to the head and neck
  • Other thyroid conditions

Thyroid nodules are uncommon in children, but have a relatively high likelihood of associated cancer. The cancer rate is lower than it has been in previous years because fewer children today have been exposed to head and neck radiation.

Symptoms

Many children with thyroid nodules do not have any symptoms, so the nodules are initially discovered during a routine physical exam. For those who do have symptoms, they may include:

Diagnosis

There are several methods for diagnosing thyroid nodules. Your child’s doctor may use a combination of these methods:

  • History and physical exam
  • Urine test
  • Blood tests to check thyroid hormone levels
  • Ultrasound (a noninvasive test that uses sound waves to take pictures of the thyroid)
  • Fine needle biopsy (removal of a small amount of thyroid tissue using a thin needle; the tissue is later examined under a microscope. Repeated biopsies may be necessary.)

Treatment

The treatment of thyroid nodules depending on the growth and development of the mass, the radiology findings, and the biopsy results.

Some nodules with benign pathology may be observed and followed over time. Other nodules may need to be surgically removed. Surgery includes removing part or all of the thyroid gland. This is recommend if the child <13 year of age, nodules that grow over time, nodules causing difficulty breathing or swallowing, or if the pathology is concerning. For patients who have had their thyroid gland removed, they may need to take thyroid replacement medication: an oral medication taken after surgery to replace the hormones that your child’s body will no longer be able to produce.

If the mass is cancer, patients may need radioactive iodine treatment. Radioactive iodine treatment involves taking a pill that targets and kills any remaining thyroid tissue left after surgery. In rare cases chemotherapy or external radiation may be required to treat extensive or residual disease.

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