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.

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.

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.

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.

“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

To find out more, read Matched to the Perfect Target, Drug Dramatically Shrinks Tumors in All Ages, Multiple Cancers  

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.

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.

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).

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

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.

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.

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.

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

• Your child’s doctor will talk with you about any new treatment options that might help your child. Then you can decide whether you want to take part.
• Find many clinical trials offered at Seattle Children’s on our Current Research Studies page or on ClinicalTrials.gov. Read our guide about searching for trials on ClinicalTrials.gov (PDF).
• Contact us at 206-987-2106.
• Email us.
• Read more about cancer research and clinical trials at Seattle Children’s.

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.

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.