Our Team’s Comprehensive Approach to Pediatric Thyroid and Endocrine Surgery
While pediatric thyroid cancer remains relatively rare, over the past 20 years, cases of the disease have increased dramatically. According to data from the Surveillance, Epidemiology, and End Results program, thyroid cancer rates have risen almost 7 percent annually from 2005 to 2016. Rates in Florida have not been an exception.
“Over the past 10 years especially, we have seen an increased number of children with thyroid cancer, usually a thyroid nodule — a mass in the neck — found by family, the patient or a pediatrician,” says Alejandro Diaz, MD, Chief of the Section of Endocrinology at Nicklaus Children’s Pediatric Specialists and Director of the Division of Endocrinology at Nicklaus Children’s Hospital.
Around 6 percent of all pediatric cancers are thyroid cancer, which is also the most common form of pediatric endocrine cancer. While these cancers are less than 2 percent of all thyroid cancers in the U.S., pediatric thyroid cancer is often more aggressive and has a very different pathophysiology than that found in adults.
“This presents a treatment challenge, as the cancer is uncommon,” Dr. Diaz says.
This challenge is one reason Nicklaus Children’s opened its Thyroid and Endocrine Surgery Center, where a dedicated team of pediatric specialists works to ensure children with thyroid cancer and other endocrine disorders receive expert surgical care.
High Surgical Volumes, Experienced Surgeons
The overwhelming majority of cases treated by the center are pediatric differentiated thyroid cancer: 90 percent are papillary thyroid cancer, and 5 to 10 percent are follicular thyroid cancer. Total thyroidectomy is the preferred treatment, followed by adjuvant radioactive iodine in advanced stages.
“With differentiated thyroid cancer, the prognosis is usually excellent, independent of the stage of the cancer,” Dr. Diaz says. “But complications from surgery can be a problem when removing the thyroid gland in children.”
Because the cancer is rare, it’s uncommon for most surgeons to have experience performing pediatric thyroidectomies. However, the Thyroid and Endocrine Surgery Center at Nicklaus Children’s, features a dedicated pediatric thyroid surgeon.
“Dr. Fuad Alkhoury has a high-volume surgical practice,” Dr. Diaz says. “His level of experience helps to ensure complication rates are very low.”
Multidisciplinary Collaboration for Improved Outcomes
Thyroid cancer treatment doesn’t just start and end with surgery.
“Evaluation and treatment of a patient with thyroid cancer requires a multidisciplinary approach,” says Adriana Carrillo Iregui, MD, Medical Director of the Diabetes Program at Nicklaus Children’s. “We have meetings once a month where we discuss all cases.”
In addition to pediatric endocrinology and surgery specialists, Nicklaus Children’s multidisciplinary care includes providers from:
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Nuclear medicine
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Oncology
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Pathology
This team of highly specialized experts focuses solely on endocrine system disorders.
“We have two interventional radiologists who are experts in biopsies of thyroids and other endocrine organs,” Dr. Diaz says. “We also have a pathologist who is an expert on thyroid and endocrine pediatric pathology.”
All providers work together to develop and monitor treatment plans.
“The beauty of our program is that everyone is involved,” Dr. Carrillo Iregui says. “If you go to another hospital, providers may be calling each other one-on-one but not talking as a group. Here, everyone is in constant communication.”
Patient Success Story
Multidisciplinary care at Nicklaus Children’s doesn’t just make a difference in treatment for thyroid and endocrine disorders. It can help with early diagnosis, too.
“I saw a 14-year-old female patient with severe acne who had high testosterone levels,” Dr. Diaz says. “During the physical exam, I found that she had a small thyroid nodule, so I ordered an ultrasound. The ultrasound showed a suspicious nodule.”
Dr. Diaz called the rest of his team and alerted them to what he had found. Within two days, the patient had a biopsy, which confirmed his suspicion of cancer. Within one week, she was in surgery. The team successfully removed the thyroid gland and began radiation therapy immediately.
While the patient’s cancer might have been detected eventually, Dr. Diaz’s expertise and thorough examination helped to ensure she wasn’t just treated for acne and sent home.
“Fortunately, she’s been doing great since treatment,” Dr. Diaz says. “She doesn't have any evidence of active cancer at this time.”
Advancing Research
In addition to advancing surgical treatment for thyroid cancers, Nicklaus Children’s is also advancing research.
“Over the past few years, we have pioneered research on the molecular makeup analysis of thyroid carcinomas, which allows us to better predict treatment outcomes and chance of recurrence,” Dr. Carrillo Iregui says.
This novel approach is not available in most pediatric cancer centers, but it can make a big difference for patients.
“Based on that molecular analysis of the thyroid cancer, we are finding new correlations that allow us to determine better surgical techniques and treatment protocols,” Dr. Carrillo Iregui says.
Beyond Treatment for Cancer
Nicklaus Children’s specializes in pediatric endocrine surgery for a wide range of conditions other than thyroid cancer, including:
Surgeons use the latest technologies and techniques, including minimally invasive robotic surgery and laparoscopic procedures.
“We have a high-quality program to take care of children with any thyroid or endocrine conditions that require surgical treatment,” Dr. Diaz says.
Email the Nicklaus Children’s physician liaison team to learn how our advanced pediatric endocrinology care can benefit your patients.