Skip to Main Content

Welcome to

Together is a new resource for anyone affected by pediatric cancer - patients and their parents, family members, and friends.

Learn More

Differentiated Thyroid Cancer

What are differentiated thyroid cancers?

Differentiated thyroid cancers (DTCs) are a type of thyroid cancer. The thyroid gland lies just below the throat in the front of the neck. The thyroid makes hormones that control body functions.
DTCs are the most common type of thyroid cancer in children.

There are 2 types of DTCs:

  • Papillary thyroid cancer
  • Follicular thyroid cancer

About 90% of thyroid cancer cases in children are papillary thyroid cancer.

Graphic of an adult female body with layover of organs visible and the thyroid gland is highlighted and labeled.

The thyroid gland lies at the base of the throat in the front of the neck. It has 2 lobes, 1 on the right and the other on the left. The thyroid gland has follicular cells that make hormones. Small parathyroid glands lie behind the thyroid.

Papillary thyroid cancer often appears as nodules in the thyroid gland. The nodules may be in one or both lobes. By the time of diagnosis, this cancer has often spread outside of the thyroid to nearby lymph nodes in the neck.

Follicular thyroid cancer starts in the follicular cells of the thyroid gland. This cancer usually stays in the neck area, but it can sometimes spread to the lungs and bones.

The thyroid gland uses iodine from the diet to make hormones. DTCs take up iodine. This feature is important for screening and treatment with radioactive iodine.

Despite the tendency for DTC to spread in children, this type of cancer has an excellent outcome with a greater than 95% survival rate.

Surgery to remove the cancer is the main treatment. Patients with intermediate and high-risk DTC may receive treatment with 131I radioactive iodine (RAI).

Symptoms of differentiated thyroid cancer

Signs and symptoms of DTC include:

  • A lump (nodule) in the thyroid gland
  • Swollen lymph nodes in the neck
  • Breathing problems
  • Problems swallowing or pain when swallowing
  • Hoarseness

Thyroid cancer does not always cause symptoms. The doctor may find it during a regular physical exam.

Risk factors for differentiated thyroid cancer

DTC occurs most often in older children and teens. Teens are 10 times more likely to develop thyroid cancer than younger children. These cancers are more common in females than males.

Gene changes and risk for thyroid cancer

Families may have genetic disorders that increase their cancer risk. Parents may pass down these conditions to their children. Changes in the child's genes may also increase their cancer risk.

Patients with DTC often have a change (mutation) in the RET gene, so it does not work properly. A child may inherit this mutation from either parent. Or your child may be the first person in your family with this gene change.

Your child's care team may suggest genetic counseling and genetic testing if your child has one of these gene changes.

Genetic syndromes (disorders) linked to DTCs include:

  • Familial adenomatous polyposis (FAP)
  • PTEN hamartoma tumor syndrome
  • DICER1 syndrome
  • Carney complex

Ionizing radiation and risk for thyroid cancer

Exposure to high doses of radiation can increase a person's risk for cancer. There is a higher risk of cancer from ionizing radiation when:

  • Patients receive radiation as a medical therapy
  • The radiation treatment includes higher doses of radiation at a younger age
  • There is environmental exposure to large amounts of radiation

Learn more about radiation safety.

Diagnosis of differentiated thyroid cancer

Doctors use several types of tests to diagnose medullary thyroid cancer. Tests may include:

  • Physical exam and health history, including a family health history, to check for inherited cancer risk and other risk factors
  • Lab tests
    • Blood tests for hormones that show how well the thyroid is working, such as thyroid stimulating hormone (TSH), T3, and free T4 (thyroxine)
    • Blood tests to look for tumor markers, including proteins such as thyroglobulin (Tg). These tests can help detect if any thyroid cancer remains after surgery or if it comes back.
    • Genetic tests to find changes in genes (mutations) that may increase the risk for cancer
  • Imaging tests to find tumors, measure their size, and see if cancer has spread. Doctors use these details to plan the next steps for diagnosis and treatment.
  • Biopsy of a sample from the tumor to see if there are cancer cells. A fine needle aspiration (FNA) allows doctors to take a thyroid tissue sample using a thin needle inserted through the skin.

Stage of differentiated thyroid cancer

The cancer stage depends on the nodule's features and if cancer has spread to other parts of the body. The stages are:

  • Stage 1: There is no cancer found outside the neck.
  • Stage 2: Cancer has spread outside the neck to distant sites.

The stage helps doctors classify patients into risk groups after surgery. In general, children with DTC have a good prognosis. However, some patients are at higher risk for more disease.

Risk group Spread of disease
Low Risk Cancer is only in the thyroid gland with little or no spread to lymph nodes.
Intermediate Risk Some cancer has spread to nearby lymph nodes.
High Risk Cancer has spread to nearby lymph nodes, tissues outside the thyroid, or other parts of the body such as the lungs.

Treatment of differentiated thyroid cancer

A team of specialists will evaluate, treat, and monitor your child's cancer. The team will balance the need for care and treatment with possible harm from treatment side effects. The team will monitor your child because:

  • Their cancer may return
  • They may have problems with hormone functions
  • There could be inherited risks

Prognosis for differentiated thyroid cancer

DTC has a greater than 95% survival rate in pediatric patients.

Recurrence is more likely in children under 10 years of age and patients whose cancer has spread to the lymph nodes before diagnosis. Even with the risk of recurrence, their chance of survival is good.

Factors that influence prognosis include:

  • How much initial surgery the patient needed
  • Whether cancer has spread to other places, such as the lungs or bones
  • Gene mutations or genetic syndromes that increase the risk of other cancers

Your child's doctor is the best source of information about your child's case.

Support for patients with differentiated thyroid cancer

After treatment, your child will need lifelong monitoring and follow-up care from a team of specialists. This care is important because:

  • There is a risk that cancer could come back (recurrence)
  • Hormone function is affected
  • Gene changes may increase the risk for other health problems or cancers

Monitoring for recurrence and follow-up care

The care team will recommend the frequency and type of tests for monitoring, which depends on individual patient needs.

Follow-up care may include:

  • Regular physical exams to check thyroid and lymph nodes
  • Ultrasound imaging of the neck and thyroid
  • TSH suppression and hormone replacement therapy (levothyroxine) after surgery
  • Monitoring blood thyroglobulin (Tg) and Tg antibodies

Recurrence of thyroid cancer can happen many years after treatment. Regular monitoring provides early detection of thyroid cancer that develops later.

Psychosocial care after thyroid and neck surgery

Care team members with Psychology, Child Life, Social Work, and other areas can help your child cope and improve their quality of life. They can assist with concerns, including:

  • Problems taking medicines daily
  • Body image concerns due to surgical scars
  • Physical therapy after surgery to assist with neck mobility and range of motion.
  • Worry about genetic conditions and future risks for cancer
  • How their diagnosis might affect future children

Adjusting to a thyroid cancer diagnosis can be challenging for families. Although the prognosis is generally good, the disease requires lifelong management with medication and monitoring. Your child may need more support as they go from adolescence to young adulthood and gain independence. Adjustment challenges may also be greater for patients who have thyroid cancer as second cancer.

Late effects of therapy

Doctors recommend that patients receiving radioactive iodine therapy be followed for possible long-term and late effects of treatment. These can include:

  • Follow-up care for problems with salivary glands and greater risk of tooth decay with dry mouth
  • Monitoring for effects on reproductive organs and fertility
  • Monitoring lung function in patients where the disease affected the lungs
  • Monitoring for more cancer that happens later (second primary cancer)

Health after cancer

All cancer survivors should live a healthy lifestyle and get regular physical checkups and screenings by a health care provider familiar with cancer survivorship issues to stay well.

Your care team may prepare a survivorship care plan. This plan is a complete record of your child's treatment, medical concerns, and health screenings they need.

Questions to ask your care team

  • What is the type and stage of cancer?
  • Is this cancer related to any genetic condition?
  • Does my child or family need genetic tests and genetic counseling?
  • What are my child's treatment options?
  • What are the possible side effects of these treatments?
  • If my child needs surgery, does the surgeon perform these surgeries often for pediatric patients with this cancer?
  • Will my child need to stay in the hospital for treatment?
  • What tests does my child need for long-term monitoring and follow-up?
  • What late effects could happen after treatment?

Key points about differentiated thyroid cancer

  • Differentiated thyroid cancers (DTCs) are the most common type of thyroid cancer in children.
  • The two kinds of DTCs are papillary thyroid cancer and follicular thyroid cancer.
  • Doctors may order lab testing, imaging studies, and a tumor biopsy to diagnose this cancer.
  • Treatments may include removal of the thyroid gland (thyroidectomy), radioactive iodine treatment, or targeted therapies.
  • For most children with DTC, the prognosis is good even if the disease has spread or come back after treatment.
  • After treatment, patients need lifelong monitoring and follow-up care.

Together does not endorse any organization mentioned in this article. 

Reviewed: December 2022