Thyroid Cancer

What is thyroid cancer?

If cells in the thyroid grow out of control, they form lumps called nodules or tumors. We do not know why this happens.

Tumors can be cancerous (malignant) or noncancerous (benign). Thyroid cancer is rare in children and teens. Most kids we treat for thyroid cancer are cured.

  • Types of thyroid cancer

    Papillary carcinoma is the most common type of thyroid cancer in children.

    Children can also get other types of thyroid cancer, including:

    • Follicular carcinoma of the thyroid
    • Medullary carcinoma of the thyroid (MCT). Children with MCT often have an inherited genetic condition called multiple endocrine neoplasia type 2 (MEN 2). 

    Our Cancer Predisposition Clinic screens and cares for children born with a gene change that raises their cancer risk.

Thyroid Cancer at Seattle Children’s

At Seattle Children's, we excellent outcomes have for children and teens with thyroid cancer. We treat more pediatric cancer than any other center in the region.

Your child will get care from doctors who are experts in childhood cancer (pediatric oncologists) and in disorders affecting the head and neck (otolaryngologists).

  • The experts you need for complete care

    Seattle Children’s has the only multidisciplinary program in the Pacific Northwest that specializes in children and teens with thyroid conditions. Our Thyroid Program brings together experts from oncology, otolaryngology, pediatric surgery, endocrinology and other fields to diagnose and treat all types of thyroid problems. Our team works together – and with you – to tailor treatment to your child.

    Our head and neck surgeons do many thyroid surgeries each year. We are considered a high-volume surgical center.

    Your child will benefit from the work of physician-scientists at Fred Hutchinson Cancer Center and UW Medicine, as well as at Seattle Children’s. The National Cancer Institute has named our partnership a comprehensive cancer center.

  • Our approach to biopsies is easier on your child

    When we need to get a sample of tissue from your child’s thyroid, Seattle Children’s surgeons perform fine-needle aspiration biopsies. This means we take a sample of cells using a very thin needle guided by ultrasound. It is less invasive than cutting into the skin. It also avoids the need for medicine that puts your child to sleep (general anesthesia).

    For most children, we can do a physical exam and a fine-needle aspiration biopsy in the same clinic visit.

  • The most advanced therapies and clinical trials

    Our treatment options for thyroid cancer include a new targeted therapy drug called Vitrakvi (pronounced vih-TRAK-vee). This drug may be an option if your child’s cancer cells have a genetic change called an NTRK gene fusion. Vitrakvi (formerly called larotrectinib) disarms that mutation and stops the cancer. The drug lets us personalize treatment based on the genetic profile of your child’s cancer. This approach is called precision medicine.

    A boy in a green shirt smiling for the camera“To watch Ashton’s health improve before our eyes over the last few months has been such a gift, we've had to pinch ourselves a few times … I can’t imagine where we would be without the treatment we got at Seattle Children’s. The drug seems like a dream for both doctors and patients.” Kayley Leeds, describing her son’s health after targeted therapy at Seattle Children’s

  • Specialists in caring for children and teens

    Our specialty is treating children’s disease while helping them grow up to be healthy and productive adults.

    Our team cares for your whole child. We don’t just treat their disease. As needed, your child will receive care from specialists in nutrition, pain management, palliative care, pharmacy, physical therapy and emotional health. Read more about the supportive care we offer.

    Children do not react to illness, pain and medicine in the same way as adults. They need – and deserve – care designed just for them. Our experts focus on how treatments today affect growing bodies in the future. We plan your child’s treatment based on years of experience and the newest research on what works best – and most safely – for children.

    We know that teens and young adults with cancer have different challenges than young children. Our Adolescent and Young Adult Cancer Program focuses on their needs.

  • Support for your whole family

    Learning that your child has a thyroid tumor can be scary. We help take positive steps right away by offering appointments in 1 to 3 days for children suspected to have cancer. If needs are not urgent, new patients can be seen in 1 to 2 weeks.

    During visits, we take time to explain your child’s condition. We help you fully understand your treatment options and make the choices that are right for your family.

    Our doctors, nurses, child life specialists and social workers help your child and your family through the challenges of their illness. We connect you to community resources and support groups.

    At Seattle Children's, we work with many children and families from around the Northwest and beyond. Whether you live nearby or far away, we can help with financial counseling, schooling, housing, transportation, interpreter services and spiritual care. Read about our services for patients and families.

Symptoms of Thyroid Cancer

Thyroid cancer may not cause symptoms in your child. But some children have:

  • A lump in the neck that you can feel
  • Voice changes because the tumor is pressing on the voice box or nerves to the vocal cords
  • Trouble breathing or swallowing

Our Cancer Predisposition Clinic screens and cares for children born with a gene change that raises their cancer risk. Finding tumors early may improve outcomes.

Check with a doctor if your child has these symptoms, which may be caused by thyroid cancer or by another problem.

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 a regular check-up.

  • Risk factors

    A child may have a greater chance of getting thyroid cancer if they have:

    • Been exposed to high levels of radiation, including past medical treatment with radiation. Low levels of radiation, such as X-rays of the teeth, are not a risk factor.
    • Graves disease.
    • Hashimoto disease.
    • Family history of thyroid cancer (familial thyroid cancer).
    • Multiple endocrine neoplasia (MEN) syndromes.
    • PTEN syndrome (Cowden syndrome).

Diagnosing Thyroid Cancer

To diagnose thyroid cancer, the doctor will:

  • Ask about your child’s health background.
  • Do an exam.
  • Feel your child’s thyroid to tell if it is a normal size and shape and whether it has lumps.
  • Do blood tests to check the levels of thyroid hormones and antibodies that can affect how the thyroid works.

To get more information about your child’s condition, the doctor may also do 1 or more of these tests:

  • Imaging studies

    Imaging studies are pictures of the inside of your child’s body. They help doctors see the size and texture of your child’s thyroid and check for nodules or other signs of disease. These studies may include:

    • Ultrasound of your child’s neck
    • CT (computed tomography) scan
    • MRI (magnetic resonance imaging) scan
    • Radioactive iodine scan
  • Fine-needle aspiration biopsy

    The purpose of a biopsy is to tell whether a lump is cancer (malignant) or not cancer (benign).

    At Seattle Children’s, our surgeons often use a biopsy method called fine-needle aspiration. This avoids giving your child medicine to make them sleep (general anesthesia). You and your child are in control – if your child feels too nervous about being awake during the biopsy, we can do a biopsy under general anesthesia.

    For most children, we can do a physical exam and a fine-needle aspiration biopsy in the same clinic visit. The biopsy visit takes about 1 hour. We have results for you in about 1 week.

    Fine-Needle Aspiration Biopsy at Seattle Children’s (Video. 3:07)

    Dr. Scott Manning explains this painless way to check a thyroid lump.

Treating Thyroid Cancer

Our treatment goal is to give your child or teen the best chance of a long and healthy life. Many of our patients return to their normal lives after treatment and never have cancer again. The doctors at Seattle Children’s Thyroid Program and Cancer and Blood Disorders Center tailor treatment to your child’s age and the needs of their growing body.

Your child's health care team will suggest a treatment plan based on:

  • The tumor size
  • Whether it has spread to the lymph nodes or other parts of the body
  • Whether your child has had radiation therapy or other exposure to radiation
  • If blood tests show a tumor marker (called thyroglobulin)
  • Your child's age and overall health
  • Your family’s preferences

Seattle Children’s offers these treatment options:

  • Surgery

    If your child has lumps in their thyroid that might be cancer or are cancer, they will have surgery. This is the most common treatment for thyroid cancer.

    • If the area of concern is only in 1 half, or lobe, of the thyroid, surgeons may remove only that half. This surgery is called lobectomy.
    • If there are concerns about both lobes, the surgeon 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 parts of the body. These lymph nodes may need to be removed, too.

    Surgery is done at our hospital campus in Seattle. 

    Read more about thyroidectomy (PDF) and surgery to treat tumors at Seattle Children’s.

  • Radioactive iodine

    A few months after surgery to remove their thyroid tumor, we will check if any cancer cells remain in your child’s body. We often use a radioactive iodine scan.

    If the test finds thyroid cancer cells, doctors will likely recommend targeted radiation with I-131. More than half of the patients we treat for thyroid cancer get targeted radiation.

    • Your child swallows a small amount of radioactive iodine.
    • The amount of radiation depends on how many cancer cells were found.
    • The radiation only affects the thyroid and thyroid cancer cells because only thyroid tissue takes up iodine.
  • Targeted therapy with Vitrakvi

    We do genetic testing if your child’s tumor does not respond to treatment or comes back after treatment. If tests show that your child’s thyroid cancer is caused by the NTRK fusion mutation, their treatment options may include the targeted therapy drug Vitrakvi. The drug targets a class of proteins known as TRK that can cause some cancers, such as thyroid cancer.  

    • The U.S. Food and Drug Administration (FDA) has approved Vitrakvi as a treatment for NTRK-fusion-positive cancer that cannot be removed by surgery or that has spread after treatment.
    • Doctors continue to study the drug’s long-term effects. In addition, our patients have access to a new Children’s Oncology Group phase 2 research study of the drug as the first therapy in children with NTRK gene fusions.
    • We also are working on faster ways to identify NTRK fusions, since knowing the genetic mutation that drives the cancer will change a child’s diagnosis and treatment.
    • Vitrakvi also is called larotrectinib sulfate, LOXO-101 and Trk inhibitor LOXO-101.

    Learn more about cancer clinical trials at Seattle Children’s

  • Thyroid hormone replacement

    If your child has surgery to remove the whole thyroid, they will need to take thyroid hormone replacement pills for life so their body gets this important hormone. If only half of the thyroid is removed, the other half will make enough thyroid hormone to meet their needs.

  • Multiple endocrine neoplasia treatment

    If a type of thyroid cancer called multiple endocrine neoplasia type 2 (MEN 2) runs in your family, your doctor may suggest genetic testing and genetic counseling. This can help tell whether your child has MEN 2 and can give you information about your options.

    Our Cancer Predisposition Clinic screens and cares for children born with a gene change that raises their cancer risk.

    Children with MEN 2 nearly always get thyroid cancer, so families may choose to have their child’s thyroid removed – most often before age 5 – to prevent cancer from starting.

Follow-up Care

Follow-up care is important after treatment ends – no matter what type of treatment your child had. The follow-up routine will depend on your child’s tumor and their treatments.

If they are taking thyroid hormone replacement, your child will need regular blood tests to make sure they get the right amount.

Our Cancer Survivor Program provides long-term follow-up care to help young people stay healthy after being treated for cancer in childhood. Most of our patients visit Seattle Children’s for follow-up care for 5 years. If you live far from Seattle, your child may get some follow-up care from a cancer doctor in your own community.

During follow-up visits at Seattle Children’s, your child’s team will:

  • Look for any signs that cancer is returning
  • Check for effects that may happen months or years after treatment
  • Tell you and your child about any risk for other cancers and signs to watch for

Contact Us

If you would like an appointment, ask your child’s primary care provider to refer you.

  • If your child has been diagnosed with cancer and you have a referral or would like a second opinion, contact the Cancer and Blood Disorders Center at 206-987-2106.
  • If your child needs their thyroid checked or has a referral for a fine-needle aspiration biopsy of the thyroid, contact Otolaryngology at 206-987-2105. Before scheduling a fine-needle biopsy, your child will need a blood test to measure thyroid-stimulating hormone (TSH). Your primary care doctor can order this test.

Providers, see how to:

Related Links

Paying for Care

Learn about paying for care at Seattle Children’s, including insurance coverage, billing and financial assistance.

For Healthcare Professionals