OHSU Doernbecher Children’s Hospital provides advanced, individual care for children’s thyroid nodules (bumps) and thyroid cancer. We offer:

• Team-based care from experts working together to create the best possible treatment plan for your child.
• Coordinated, same-day doctor visits and tests for quicker diagnosis and treatment.
• The latest technology and surgical procedures by doctors who specialize in children’s thyroid conditions and in head and neck surgery.
• Close collaboration with pediatric sedation team as needed, to appropriately manage your child’s condition and comfort during procedures.

Understanding thyroid nodules

Growths in the thyroid gland are rare in young children and are usually not cancer. However, they should be fully evaluated because they more likely be cancer in children than in adults.

If cancer is found, it is usually highly curable, with 98 percent of patients surviving at least 20 years after diagnosis.

What are thyroid nodules?

Thyroid nodules are bumps that grow in the thyroid, a butterfly-shaped gland that straddles the windpipe (trachea) at the front of the neck.

The thyroid produces hormones that regulate metabolism (how your body turns food into energy) and that help control vital functions such as blood pressure, heart rate, body temperature and growth. In some cases, cancer can develop when cells in the thyroid grow out of control.

Who gets thyroid nodules?

Thyroid nodules are uncommon in childhood. Less than 2 percent of children are estimated to have thyroid nodules. Of those, thyroid cancer is present in about one in five children to one in four children.

Thyroid cancer is a rare form of childhood cancer, with two cases diagnosed for every 1 million children under age 15 each year in the U.S.

Types of thyroid nodules

Benign (noncancerous) nodules: These growths in the thyroid can be solid or filled with fluid. They are usually not harmful.

Thyroid cancer: When the thyroid cells grow out of control, they form cancerous tumors. Left untreated, the cancer can spread. Thyroid cancer also comes in several types. Your child’s care team will be able to explain the different types and best treatment for each.

Causes of thyroid nodules and thyroid cancer

The cause of thyroid nodules and thyroid cancer is usually unknown. Risk factors include:

• Age: The risk increases with age. Teenagers are more likely to have thyroid cancer than 9-year-olds, for example. About half of adults have nodules by age 60.
• Gender: Girls and women are at higher risk.
• Family history: Your child’s risk is higher if thyroid disease runs in your family. Some inherited genetic conditions also increase risk. They include multiple endocrine neoplasia syndromes, Cowden syndrome and Bannayan-Riley-Ruvalcaba syndrome. OHSU’s genetic experts can provide counseling and testing to help you identify and manage any risk.
• Radiation exposure: Exposure in the environment or from medical treatments raises risk.
• Low iodine levels: People who don’t have enough iodine in their diets, rare in the U.S., are at higher risk.

Symptoms of thyroid nodules

Thyroid nodules usually don’t have any symptoms, but you might see or feel a lump in the front of your child’s neck. Doctors sometimes discover nodules while checking the neck during a medical exam. In rare cases, a nodule can cause pain, a throat tickle, hoarseness or trouble breathing and swallowing.

Diagnosing thyroid cancer

We offer the latest diagnostic and screening services all on one day. They include:

• Blood tests: A sample of your child’s blood will be analyzed to determine how well the thyroid is working.
• Ultrasound: High-energy sound waves are used to create an image of the inside of your child’s neck, including the thyroid gland and lymph nodes. It is a painless procedure using a small device on the outside of your child’s neck. Additional scans, such as with a CT scan (computed tomography scan) machine, are sometimes done.
• Fine needle aspiration biopsy: A thin needle is used to take a small tissue sample for cancer analysis. We numb the area and also offer sedation for children and teens who are anxious about the procedure.

Team-based care

Our pediatric thyroid specialists will work together to make sure your child receives the best care possible. Our team includes experts in:

• Endocrinology (hormone and thyroid conditions)
• Neck and endocrine surgery (otolaryngology)
• Oncology (cancer and cancer treatment)

They work closely with other experts at Doernbecher and at OHSU’s Knight Cancer Institute, one of the nation’s top cancer centers.

Treatment of thyroid nodules and thyroid cancer

Monitoring: Benign nodules are usually monitored with an ultrasound every six to 12 months to check for growth or other changes.

Surgery: If cancer is found, the most common treatment is surgery to remove part or all of the thyroid. The surgeon may also remove lymph nodes to check for signs of cancer. Our highly trained surgeons are experts in head and neck surgery endocrine surgery and use surgical techniques that allow for smaller incisions, less pain and quicker recovery.

Other cancer treatments:

• Radiation therapy to eliminate any remaining cancer cells after surgery.
• Chemotherapy medications given intravenously to kill cancer cells, only for advanced thyroid cancers.
• Targeted therapy: Pills or intravenous medicines that target specific molecules in the cancer cells while limiting damage to normal cells.

Doernbecher services

• Childhood Cancer Survivorship Program
• Support services for your child and family

Thyroid information

• Thyroid Nodules, American Thyroid Association
• Thyroid Cancer, National Cancer Institute
• Unusual Cancers of Childhood, National Cancer Institute
• Pediatric Thyroid Cancer, ThyCa: Thyroid Cancer Survivors’ Association