“My son has thyroid nodules. What happens if they are malignant?”
My 13 year old son was diagnosed with thyroid nodules and he'll be having a biopsy next week. I'm terrified. What happens if the nodules are malignant? What would the next steps be?
5 Answers
Sorry to hear about that but good that they were detected. If the biopsy shows malignancy, then depends a bit on how small or large they are and how many there are as well as their exact location. Usually surgical removal and then consideration for radioiodine treatment. If enough thyroid tissue is removed because of location and/or size, then likely there will need to be a once-a-day thyroxine pill provided to ensure adequate thyroid function for his health, growth and well-being. If radiation treatment is needed, usually this also destroys the nearby normal thyroid tissue and so one ends p being hypothyroid too and needing the same thyroxine daily pill. Important that you are working with an experienced pediatric thyroid specialist/endocrinologist who can confer with surgeon and any thyroid cancer specialists to make such decisions. Stuart Brink, MD Senior Endocrinologist, New England Diabetes & Endocrinology Center (NEDEC) c/o NEDEC, 196 Pleasant Street, Newton Centre MA 02459-1815, USA phone 1-781-572-4533, e-mail: stuartbrink@gmail.com
Will be thyroidectomy and depends if chemotherapy is needed.
Please have a clear conversation with his endocrinologist, he is the best person that can give you answers about your son.
`The thyroid gland is very important gland that makes an important hormone called thyroid hormone. It also makes other important hormones. it is located at the base of the neck. It is homogeneous in consistency. it has three parts the right lobe left lobe and an isthmus (bridge). In an adult person it weighs about 25 grams. Its diagonal size is about 3 cm. If greater than 3 cm it is called a goiter (enlarged thyroid gland). Some times it could have a bump called a nodule. A nodule can be cystic or solid. It can be calcified or have abnormal vasculature. It could be benign or neoplastic (cancerous).
The first step in the evaluation of thyroid nodule is physical palpation of the thyroid gland. Some times the nodule is visible to the naked eyes and may need fine needle aspiration biopsy right away (in children unlike in adults). However after physical palpation of the thyroid gland the next step is the use of ultrasound of the thyroid gland to determine if this is solid, cystic, calcified or have abnormal vasculature. If it is cystic with normal vasculature and no calcification, only follow up monitoring is needed. But it is calcified or the vasculature is abnormal then, biopsy is required to determine for its cytological studies. If the biopsy say neoplastic tissue then the nodule needs to be removed.
If the ultrasound shows solid mass the size needs to be determined. In children if the size is small (less than 10mm) only monitoring is needed. If the nodule is greater than 10 mm in size (large nodule) biopsy is advisable.
If the biopsy shows benign cell only monitoring is required. But if it is neoplastic then determination should be done it has spread to the surrounding area including the adjacent lymph nodes. If it did not spread out of the capsule, the removal of the side of the thyroid where it resides (partial thyroidectomy or lobectomy) or the whole thyroid should be removed depending on the circumstances. However if it spread out of it place to the surrounding area total thyroid removal and removal of the surrounding lymph nodes followed by radioiodine ablation should be performed. After 6-12 months whole body scan with radioiodine should be performed to determine complete destruction of malignant cell. Once the whole thyroid is removed the patient will be on thyroid hormone replacement life time. The dose should be titrated higher than normal to suppress the TSH to below 0.5 miu/ml. TSH, Thyroglobulin and thyroglobulin antibodies need to be monitored on regular basis to assure optimum therapy and suppression. Prognosis of thyroid neoplasia in most case is excellent if caught early and treated well depending on the type of the neoplasia. There are different types of thyroid neoplasia but they are beyond the scope of this discussion.
To go back to your question your son could have any of the above cases. But only 1/3 childhood nodules may be abnormal. Over 2/3 of the nodules are likely benign in children. So statically speaking he will have a better chance of having benign results than abnormal. But basically the above discussion will give a reasonable ideal how thyroid nodules are approached. In adults only about 5% of thyroid nodules are worrisome. In adults doctors may not be aggressive and the guidelines a bite different though the approach similar. I am sorry I did not respond to you concern on time. At last I would like to say medicine is an art and you are going to see some differences in approach. Listing to your sons doctor is very important.
Good luck.
The first step in the evaluation of thyroid nodule is physical palpation of the thyroid gland. Some times the nodule is visible to the naked eyes and may need fine needle aspiration biopsy right away (in children unlike in adults). However after physical palpation of the thyroid gland the next step is the use of ultrasound of the thyroid gland to determine if this is solid, cystic, calcified or have abnormal vasculature. If it is cystic with normal vasculature and no calcification, only follow up monitoring is needed. But it is calcified or the vasculature is abnormal then, biopsy is required to determine for its cytological studies. If the biopsy say neoplastic tissue then the nodule needs to be removed.
If the ultrasound shows solid mass the size needs to be determined. In children if the size is small (less than 10mm) only monitoring is needed. If the nodule is greater than 10 mm in size (large nodule) biopsy is advisable.
If the biopsy shows benign cell only monitoring is required. But if it is neoplastic then determination should be done it has spread to the surrounding area including the adjacent lymph nodes. If it did not spread out of the capsule, the removal of the side of the thyroid where it resides (partial thyroidectomy or lobectomy) or the whole thyroid should be removed depending on the circumstances. However if it spread out of it place to the surrounding area total thyroid removal and removal of the surrounding lymph nodes followed by radioiodine ablation should be performed. After 6-12 months whole body scan with radioiodine should be performed to determine complete destruction of malignant cell. Once the whole thyroid is removed the patient will be on thyroid hormone replacement life time. The dose should be titrated higher than normal to suppress the TSH to below 0.5 miu/ml. TSH, Thyroglobulin and thyroglobulin antibodies need to be monitored on regular basis to assure optimum therapy and suppression. Prognosis of thyroid neoplasia in most case is excellent if caught early and treated well depending on the type of the neoplasia. There are different types of thyroid neoplasia but they are beyond the scope of this discussion.
To go back to your question your son could have any of the above cases. But only 1/3 childhood nodules may be abnormal. Over 2/3 of the nodules are likely benign in children. So statically speaking he will have a better chance of having benign results than abnormal. But basically the above discussion will give a reasonable ideal how thyroid nodules are approached. In adults only about 5% of thyroid nodules are worrisome. In adults doctors may not be aggressive and the guidelines a bite different though the approach similar. I am sorry I did not respond to you concern on time. At last I would like to say medicine is an art and you are going to see some differences in approach. Listing to your sons doctor is very important.
Good luck.
I appreciate your concerns about your child's health. In general, thyroid nodules in children tend to be malignant more frequently than in adults. However, the majority of thyroid conditions in children are benign. If the nodules do turn out to be malignant, then it is likely that further surgical and medical care will be needed. Identifying a team of physicians and surgeons that have experience with thyroid malignancies and who can support you and your son through this experience is important. It is likely that your son will need to start some type of thyroid hormone replacement and will need to have monitoring of thyroid hormone and thyroid function related levels checked to be sure that his health is being supported. You will need to ensure that you follow up with your care team as they monitor for growth or spread of any suspicious tissue. Overall, thyroid malignancies tend to be less aggressive than some other types of cancer.
