Are There Differences in the Presentation of Thyroid Nodules and Thyroid Cancer in Adults and Children?

By Andrew J. Bauer, M.D. and Gary L. Francis, M.D., Ph.D., Reprinted, with permission, from page 101of Chapter 12 of the book "Thyroid Cancer: A Guide for Patients", (Douglas Van Nostrand, M.D., Gary Bloom, and Leonard Wartofsky, M.D., editors, Keystone Press, 2010.) See http://www.thyca.org/about/TCGuide/.

Yes. While the majority of thyroid nodules are not cancer, there is an increased risk that nodules in children will be cancer. Because of this, all thyroid nodules in children should be evaluated thoroughly and quickly. Unfortunately, there is no blood or x-ray test that allows us to distinguish which nodules are cancer.

Unlike adults, about half the children with thyroid cancer have swollen glands (enlarged lymph nodes) that can be felt in the neck. These lymph nodes are usually swollen because of small amounts of cancer that have spread to them, and while this predicts a worse outcome for adults, it does not predict a worse outcome in children.

In addition to lymph-node involvement, almost 15 percent of children have cancer that has already spread to the lungs (pulmonary metastasis). While metastases to the lungs can be associated with much reduced survival in adults, this does not appear to be true in children.

Many children will continue to have persistent disease in the lungs that does not increase or worsen in the next 15 to 20 years. In fact, the lung disease may slowly decrease in size years after the last 131I dose

One of our greatest limitations has been a lack of long-term outcome data. However, one recent study reported results on 188 children and adolescents who had been followed for as long as 60 years after diagnosis. Recurrent disease developed in about one third of the patients (27 percent at 20 years and 33 percent at 40 years). However, an increase in overall mortality caused by second cancers did occur, but most of these developed in long-term survivors who received radiation as part of their thyroid cancer treatment (external beam, radium implant, radioactive iodine, or combinations). Of the 188 children, only 1 percent died as a direct result of their thyroid cancer.