Endocrine and Immune System Conditions

Thyroid Conditions

What are thyroid conditions?

The thyroid is a small gland in the front of the neck. It is shaped like a butterfly. One half (lobe) of the thyroid lies along one side of the windpipe, and one half lies along the other side. It is between the Adam’s apple and the breastbone.

A healthy thyroid makes hormones that control metabolism — the way the body breaks down food and uses or stores the energy. Your child’s thyroid function affects their growth and development.

Children can get thyroid conditions, which include:

  • Thyroid nodules are small lumps that form in the thyroid. They can be fluid-filled sacs (cysts) or solid masses. Most thyroid nodules are benign (not cancer), but some are malignant (cancer).

  • The most common type of thyroid cancer in children is called papillary carcinoma. Children can also get other types of thyroid cancer, including follicular carcinoma of the thyroid and medullary carcinoma of the thyroid (MCT). MCT can run in families. Some children with thyroid cancer have another condition that runs in families called multiple endocrine neoplasia type 2 (MEN II).

Graves disease and Hashimoto’s disease are becoming more common. These conditions seem to lead to thyroid nodules and thyroid cancer in children and adolescents.

Problems with parathyroid glands

Near the thyroid are 4 small glands called the parathyroid glands. These control the level of calcium in the body. They can also develop problems, like being overactive (hyperparathyroidism). Overactive parathyroid glands cause your child’s calcium level to be higher than normal.

Thyroid Conditions at Seattle Children’s

Seattle Children’s has the only multidisciplinary program in the Pacific Northwest that specializes in children and teens with thyroid conditions. The Thyroid Program brings together experts from endocrinology, otolaryngology, general surgery, oncology and other fields to diagnose all types of thyroid conditions and provide treatment tailored to your child.

  • We work as a team, making sure you are connected with the specialists your child needs. Many children with thyroid problems see our endocrinologists, who are often able to treat the problem with medicine alone. If surgery is needed, our surgeons are experienced at performing thyroid surgeries in infants, children and teens. For children with thyroid cancer, Seattle Children’s oncologists offer the most advanced treatment options.

  • When we need to get a sample of tissue from your child’s thyroid, Seattle Children’s otolaryngologists perform fine-needle aspiration biopsies. This means we take a sample of cells using a very thin needle guided by ultrasound. It is not as invasive as cutting into the skin. For most children, we can do a physical exam and a fine-needle aspiration biopsy in the same clinic visit and avoid the need for general anesthesia.

  • Dr. Marguerite T. Parisi has been involved in many studies of radioactive iodine (radioiodine, or I-131) therapy, used for overactive thyroid.

    Research on fine-needle aspiration biopsies for thyroid conditions shows our results for children and adolescents are as accurate as the results of doctors doing these biopsies for adults.

    A study at Seattle Children’s showed our patients are ready to leave the hospital sooner after surgery to remove the thyroid. This is because of the ways we carefully manage low levels of calcium in the blood (hypocalcemia) — which can happen when surgery disturbs blood flow to the parathyroid glands.

Symptoms of Thyroid Conditions

The symptoms of thyroid conditions depend on the type of problem, including whether it causes too much or too little thyroid hormone.

Some children with thyroid conditions have no symptoms.

  • Children with too much thyroid hormone (hyperthyroidism) may:

    • Be more nervous, agitated or emotional than usual
    • Have trouble sleeping
    • Lose weight even though they seem to be eating enough
    • Sweat more than normal
    • Have heart palpitations (flutters or skips in their heartbeat)
    • Have high blood pressure
    • Have diarrhea

    Overactive thyroid can make the thyroid get bigger. An enlarged thyroid is called a goiter. A goiter may be small and not cause any symptoms, or it may cause:

    • Swelling at the front of the neck, on both sides or only 1 side, that you can see or feel
    • Pressure or tightness in the neck or throat if the goiter is very large. This might affect how your child swallows or breaths, cause coughing or make your child hoarse.

  • Children with too little thyroid hormone (hypothyroidism) may:

    • Seem sluggish or have low energy
    • Be depressed
    • Start gaining weight even though they have not changed their eating or exercise

  • Thyroid nodules and thyroid cancer do not usually cause symptoms. Both conditions may cause a lump in the neck that you, your child or a healthcare provider can feel.

    Sometimes thyroid cancer causes these symptoms:

    • Enlarged thyroid and enlarged lymph nodes in the neck
    • Voice changes because the thyroid is near the voice box (larynx) and nerves to the vocal cords

  • Overactive parathyroid glands can cause high levels of calcium in the blood, which can lead to these symptoms:

    • Feeling tired, weak and not well overall
    • Having kidney stones
    • Having headaches
    • Being constipated

Diagnosing Thyroid Conditions

If your child has symptoms of overactive or underactive thyroid or a lump in the neck, the doctor will ask about your child’s health background and do an exam. This will include feeling your child’s thyroid to tell whether it is a normal size and shape and whether it has nodules.

If your child has no symptoms, you may find out about a thyroid problem because the doctor feels something that is not normal in your child’s neck during your child’s regular check-up.

To get more information about your child’s condition, the doctor may ask for 1 or more of these tests.

  • Imaging studies such as an ultrasound of your child’s neck allow doctors to see pictures of the inside of your child’s body. They can look at the size and texture of your child’s thyroid and check for nodules or other signs of disease.

  • If your child has a thyroid nodule or thyroid mass, they might need a biopsy. The purpose of a biopsy is to tell whether a nodule or mass is cancer (malignant) or not cancer (benign).

    At Seattle Children’s, we use a biopsy method called fine-needle aspiration, done by our otolaryngologists. For most children, we can do a physical exam and a fine-needle aspiration biopsy in the same clinic visit and avoid the need for general anesthesia.

    We numb the front of the neck using a needle-free device called a J-tip that pushes medicine (buffered lidocaine) into your child’s skin with a strong puff of air. Then we use a very thin needle (thinner than for a blood draw) to take a sample of cells. We use ultrasound to guide the needle to the right place.

    The biopsy visit takes about 1 hour. We have results for you in about 1 week.

    You and your child are in control — if your child feels too nervous about being awake during the biopsy, we schedule a biopsy under general anesthesia (so your child is unconscious) instead.

Treating Thyroid Conditions

Thyroid hormones (and other hormones) are closely linked to a child’s growth and development, so children with thyroid conditions need to see pediatric experts.

The doctors at Seattle Children’s Thyroid Program specialize in kids, and they will tailor treatment to your child’s age and the needs of your child’s growing body.

Our pediatric endocrinologists may be able to diagnose and treat your child’s thyroid problem with no need for surgery. Medicine may be all your child needs to correct too much or too little thyroid hormone.

If your child does need surgery, our experienced surgeons will work closely with the rest of your child’s healthcare team and with you to tell which procedure is best and how to fit it in with the rest of your child’s treatment.

  • Medicines

    For a child with too much thyroid hormone (hyperthyroidism), including Graves disease, doctors may prescribe a medicine to take by mouth every day to block thyroid activity. Common medicines for this are called propylthiouracil and methimazole. Or doctors may suggest treatment with radioactive iodine (radioiodine, or I-131) taken by mouth. The thyroid gland tends to take up, or concentrate, any iodine in the body. Then the radioactivity shrinks the thyroid, lowering the amount of hormone.

    Surgery

    A child with overactive thyroid may need surgery to remove the thyroid if any of these things happens:

    • The medicine doesn’t correct their hormone level.
    • The medicine causes unwanted side effects or an allergic reaction.
    • The child cannot have radioactive iodine because of their age or size.
    • The thyroid has gotten too large.

  • For a child with too little thyroid hormone (hypothyroidism), including Hashimoto’s disease, doctors may prescribe pills of thyroid replacement hormone. This can keep the hormone level in the right range. Children taking these pills need to take them for life and see the doctor regularly. The doctor will check their hormone level and adjust their medicine as they age and grow.

  • A child with thyroid nodules that clearly are benign (not cancer) might have surgery to remove the nodules if they are large enough to cause problems, such as trouble swallowing or breathing.

  • A child with nodules that might be cancer or are clearly cancer will have surgery.

    • If the area of concern is only in one half, or lobe, of the thyroid, surgeons may remove only that half. This surgery is called lobectomy.
    • If there are concerns about both lobes, they will remove the whole thyroid. This is called total thyroidectomy.

    If there is cancer in the thyroid, doctors will also check whether the cancer has spread to nearby lymph nodes or other structures. These may need to be removed, too.

    After surgery to remove the whole thyroid, children need to take thyroid hormone replacement pills for life so their bodies get this important hormone. If only half of the thyroid is removed, the other half will make enough thyroid hormone to meet their needs.

    Very few children and adolescents with thyroid cancer need chemotherapy or radiation therapy. Our surgeons work with our childhood cancer doctors and nuclear medicine doctors to create a treatment plan for each child based on the child’s needs.

    Seattle Children’s cancer program is part of Seattle Cancer Care Alliance, along with UW Medicine and Fred Hutchinson Cancer Research Center.

  • If you have been told that multiple endocrine neoplasia type 2 (MEN II) runs in your family, your doctor may suggest genetic testing and genetic counseling. This can help tell whether your child has MEN II and can give you information about your options. Children with MEN II nearly always get thyroid cancer, so families may choose to have the child’s thyroid removed early on — usually before age 5 — to prevent cancer from starting.

  • For 1 or more overactive parathyroid glands, surgeons may remove the glands causing the problem. There are 4 parathyroid glands near the thyroid. The body only needs 1 for normal function.

Contact Us

Contact Otolaryngology at 206-987-2105 to request an appointment, second opinion or more information if your child:

  • Needs a thyroid nodule checked
  • Has a referral for a fine-needle aspiration biopsy of the thyroid
  • Was diagnosed with thyroid cancer

If your child has any other thyroid concern or symptoms of thyroid problems, contact Endocrinology at 206-987-2640.