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Differentiated Thyroid Cancer

What is differentiated 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.

A differentiated thyroid cancer (DTC) is a type of thyroid cancer. The thyroid gland is just below the throat in the front of the neck. It 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: Often appears as small lumps (called nodules) in the thyroid gland. These lumps are made up of abnormal cells and can grow in 1 or both parts (lobes) of the thyroid. By the time doctors find this cancer, it has often spread to nearby lymph nodes in the neck.

  • Follicular thyroid cancer: Starts in the thyroid gland’s follicular cells. These cells make hormones to control metabolism. Follicular thyroid cancer usually stays in the neck area. But it can sometimes spread to the lungs and bones.

About 90% (9 of 10) of thyroid cancer cases in children are papillary thyroid cancer.

The thyroid gland uses iodine from your food to make hormones. Iodine is a mineral that your body needs to stay healthy. Your thyroid gland uses iodine to make hormones that control your metabolism, energy levels, and growth. Differentiated thyroid cancers absorb iodine. This is important for screening and treatment with radioactive iodine.

Surgery to remove the cancer is the main treatment. Patients with intermediate and high-risk DTC may receive treatment with a special form of iodine called I-131 radioactive iodine. This type of iodine gives off a small amount of energy. The treatment helps target and destroy any remaining thyroid cells.

Differentiated thyroid cancer has an excellent outcome with a greater than 95% survival rate.

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

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

Gene changes and risk for thyroid cancer

Patients with DTC often have a gene change (mutation) that can cause thyroid cancer. A child may inherit the mutation from either parent. Or your child may be the first person in your family with this gene change.

Families may have genetic disorders that increase their cancer risk. Parents may pass down these conditions to their children.   

Genetic syndromes (disorders) linked to differentiated thyroid cancers include:

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

Your care team may suggest genetic counseling and genetic testing.

Ionizing radiation and risk for thyroid cancer

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

  • A patient receives radiation as part of medical treatment
  • A person is exposed to high doses of radiation at a young age 
  • There is environmental exposure to large amounts of radiation, such as from nuclear accidents or certain workplace conditions

Learn more about radiation safety.

Diagnosis of differentiated thyroid cancer

Doctors use several types of tests to diagnose differentiated 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 the cancer comes back.
    • Genetic tests to find changes in genes (mutations) that may increase the risk of cancer
  • Imaging tests to find tumors, measure their size, and see if the 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 allows doctors to take a thyroid tissue sample using a thin needle inserted through the skin.

Stages 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: No cancer is 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.

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. 

Treatment for differentiated thyroid cancer almost always begins with surgery, but may also include thyroid hormone therapy, radioactive iodine treatment, tyrosine kinase inhibitors, redifferentiation therapy and/or clinical trials.

  1. Surgery for differentiated thyroid cancer

    Surgery to remove the thyroid gland (thyroidectomy) is the main treatment for thyroid cancer. This surgery:

    • Lowers the risk of more thyroid cancer
    • Helps with follow-up care using radioactive iodine for imaging and treatment

    Before surgery, the care team will do an ultrasound and a fine-needle aspiration on any lymph nodes that may have cancer. This helps the doctor plan the surgery.

    If the tumor is small, the surgeon may do a partial thyroidectomy. This procedure only removes 1 lobe and the isthmus of the thyroid gland. The isthmus is the thin band of tissue that connects the 2 lobes of the thyroid gland.

    Your child's doctor may also remove lymph nodes and other tissues in the center or sides of the neck. This procedure is known as a neck dissection. The surgeon may remove lymph nodes that interact with the thyroid gland and may have cancer cells. High-risk patients may need more surgery to stop cancer from returning.

    Risks of thyroid surgery

    During thyroid surgery, there is a risk of damage to neck structures and parathyroid glands.

    The parathyroid glands are 4 small glands that lie behind the thyroid. These glands release parathyroid hormone. This hormone keeps calcium levels at a normal level in the body.

    Sometimes, the parathyroid glands are harmed during surgery. The parathyroid glands may become "stunned” even if they are not damaged. This results in hypoparathyroidism and low levels of parathyroid hormone.

    Symptoms include:

    • Low levels of calcium in the blood (hypocalcemia)
    • Numbness and tingling in the hands, feet, and face
    • Muscle cramps

    Doctors treat this condition with vitamin D (calcitriol) and calcium supplements until these problems stop. Hypothyroidism may be temporary or permanent.

    Nerve or vocal cord problems

    Another risk of thyroid surgery is nerve damage to the recurrent laryngeal nerve. This nerve helps the vocal cords move for speech. Nerve problems after thyroid removal are rare.

    A specialist will do a "scope" procedure to check the vocal cords before and after surgery. The doctor will gently place a small, flexible camera into your child's nose to see the vocal cords and check their function.

    Vocal cord injuries during surgery are often temporary. But some patients may need a longer recovery time, even a year or longer.

    Patients may need more treatment if their voice changes or they have problems breathing or swallowing. The doctor can inject a special filler into the vocal cords to help them work better while the nerve heals. This filler is made of safe materials that the body slowly absorbs over time. Sometimes, the patient may need surgery to improve vocal cord function.

    After surgery, patients will have follow-up tests to decide if other treatments are also required.

  2. Thyroid hormone therapy for differentiated thyroid cancer

    After surgery, the doctor monitors low-risk patients with regular screening. They may receive a medicine called levothyroxine (or T4). It blocks thyroid stimulating hormone (TSH). This is known as TSH suppression. TSH suppression keeps TSH hormone levels low, which can help stop tumor cell growth.

    Monitoring includes:

    • Blood tests for thyroglobulin (Tg) protein
    • Tests for thyroglobulin antibody levels
    • Ultrasound imaging to find any cancer

    Some intermediate-risk and all high-risk patients receive TSH-stimulated thyroglobulin and a diagnostic whole-body scan. This scan looks for the spread of thyroid cancer to other parts of the body.

    For this test:

    • The care team gives the patient a radioactive tracer, usually radioiodine I-123. This level of radiation is quite low. 
    • Thyroid cells normally use iodine to make hormones. Thyroid cancer cells do the same, so they take up the tracer.
    • The radiologist takes pictures using a special camera that can see the tracer. The pictures show the location of cancer in the body.

    Based on the results and thyroglobulin levels, the doctor may treat the patient with radioactive iodine to kill the cancer cells. The patient may have more surgery to remove the cancer.

  3. Radioactive iodine treatment for differentiated thyroid cancer

    Patients with intermediate and high-risk differentiated thyroid cancer may receive I-131 radioactive iodine treatment.

    In this therapy, the care team uses a special form of iodine that gives off a small amount of radiation. Thyroid cells and thyroid cancer cells absorb the iodine, which allows the radiation to work inside the body to destroy the cancer cells. This also helps treat cancer that may have spread to other areas.

    Doctors carefully plan this treatment to keep the rest of the body safe. The radiation mainly targets thyroid cells and does not stay in the body for long. Patients may need to follow safety steps for a short time, like avoiding close contact with others, until most of the radiation has left their body.

    Some studies have suggested that this treatment may slightly increase the risk of second cancers. But researchers are still studying these effects, especially in children and teens. The medical team and family must weigh the risks and benefits to choose the best treatment plan. 

    Low iodine diet

    Your child must stay on a low-iodine diet for 7 days before receiving I-123 or I-131. You can learn more about a low-iodine diet at:

     

  4. Tyrosine kinase inhibitors for differentiated thyroid cancer

    Doctors are studying targeted therapies such as tyrosine kinase inhibitors for cancer that does not respond to standard treatments. These medicines work by blocking signals that make cancer cells grow and spread. They can also shrink tumors and help patients feel better by reducing symptoms such as pain, trouble breathing, or difficulty swallowing.  

    Some tyrosine kinase inhibitors used for children with advanced cancer include:

    • Lenvatinib 
    • Lartotrectinib: Used for differentiated thyroid cancer that has changes in TRK gene
    • Lorlatinib: Used for differentiated thyroid cancer that has changes in ALK gene
    • Selpercatinib and pralsetinib: Used for differentiated thyroid cancer that has specific changes in the RET gene 

    Possible side effects of tyrosine kinase inhibitors include high blood pressure, fatigue, diarrhea, skin rash, and liver problems. Long-term effects in children are still being studied.

  5. Redifferentiation therapy for differentiated thyroid cancer

    Some thyroid cancers stop taking in iodine, so radioactive iodine treatment no longer works. This happens when certain genes get “turned off,” meaning they stop working properly. Genes act like switches that control how cells behave. When these switches turn off, the cancer cells lose their ability to absorb iodine.

    Redifferentiation therapy helps turn these genes back on. This allows the cancer cells to absorb iodine again, so radioactive iodine treatment can work to destroy them.

    Doctors will check for changes in the BRAF, MEK, RET, ALK and NTRK genes before deciding if this treatment is right for a patient. 

    Redifferentiation therapy may use tyrosine kinase inhibitors, which include:

  6. Clinical trials for differentiated thyroid cancer

    Patients with advanced disease or disease that comes back may consider enrolling in a clinical trial.

Prognosis for differentiated thyroid cancer

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

Cancer is more likely to come back (recur) 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 health care provider is the best source of information about your child's case.

Finding Support Through Friendship

Friendship helped patient Emma Gilpen navigate thyroid cancer treatment.

Read her story

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
  • 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 your child’s 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 and its antibodies

Thyroid cancer can come back many years after treatment. Regular monitoring helps doctors find thyroid cancer early if it comes back.

Psychosocial care after thyroid and neck surgery

Care team members with psychology, social work, and other areas can help your child cope and improve their quality of life. Child life staff can also assist with concerns such as:

  • 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 who get radioactive iodine therapy be followed for possible long-term and late effects of treatment. Long-term effects are side effects that start during or soon after treatment and continue for a long time. Late effects are side effects that appear months or even years after treatment. 

Follow-up care may include appointments to check for:

  • Problems with salivary glands and tooth decay caused by dry mouth
  • Effects on reproductive organs and fertility
  • Lung function in patients where the disease affected the lungs
  • Other cancers that happen 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 problems.

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 my child’s differentiated thyroid cancer?
  • Is this thyroid cancer related to any genetic condition?
  • Does my child or family need genetic tests and genetic counseling?
  • What are my child's treatment options for this thyroid cancer?
  • What are the possible side effects of these treatments?
  • If my child needs surgery, does the surgeon perform these surgeries for pediatric patients with this cancer?
  • What tests does my child need for long-term monitoring and follow-up?

Key points about differentiated thyroid cancer

  • Differentiated thyroid cancers (DTCs) are the most common type of thyroid cancer in children.
  • Types of differentiated thyroid cancer include 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 surgery, thyroid hormone therapy, radioactive iodine treatment, or targeted therapies.
  • For most children with differentiated thyroid cancer, 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.

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TheTogether by St. Jude™ online resource does not endorse any organization mentioned in this article. 

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Reviewed: May 2025

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