Nationally, the incidence of pediatric thyroid cancer is rising. Because thyroid cancer in children doesn’t typically present with symptoms or significant lab findings, it’s imperative that pediatricians screen for nodules and refer patients to a specialized thyroid team when indicated.

Directed by pediatric endocrinologists Laura C. Page, MD and Michael S. Freemark, MD, the Duke Pediatric Comprehensive Thyroid Clinic treats pediatric patients with thyroid nodules, thyroid cancer, and/or an increased risk of thyroid cancer. The clinic was established in 2018 as one of the first in the nation, and advocates for the earliest possible specialized care to treat—and cure—pediatric thyroid cancer.

Page says, “After pediatricians or pediatric endocrinologists refer their patients to our team, we coordinate all additional studies, including lab testing and imaging. We create comprehensive care plans with multiple Duke specialists, including pediatric radiologists, thyroid surgeons, pathologists, pediatric oncologists, and nuclear medicine physicians.”

Throughout a patient’s continuum of care, Page and her team communicate often with pediatricians and families. “We share clinic notes, and we are available to answer questions, so everyone is informed and confident in the child’s care plan.”

"Our team’s shared goal is to minimize morbidity and maximize quality of life. Pediatric thyroid cancer has a very good prognosis, but still has major impacts on children and their families. We aim for the best treatment outcomes with the lowest risks from diagnosis to long-term follow-up care,” says Page.

One example of the team’s commitment to the best outcomes is the collaborative approach between endocrine surgeon, Randall P. Scheri, MD and pediatric surgeon, Tamara Fitzgerald, MD, PhD.

Scheri, who performs more than 300 thyroid surgeries per year in adults and children, and Fitzgerald partner to share expertise that delivers leading-edge surgical techniques with lower risks for surgical complications.

For more advanced cancer cases, the team also collaborates with nuclear medicine specialists. Page says, “Duke offers specialized approaches to radioactive iodine therapy, such as dosimetry. We discuss challenging cases to aim to deliver the right dose to cure disease while minimizing risks of side effects.”

The Durham clinic continues to see increasing referrals, treating patients from nearby counties as well as eastern and western North Carolina, West Virginia, and South Carolina. Over the last three years, patient volumes have grown by over 40%.

“We’re seeing more patients while also expanding research initiatives,” says Page.

In the fall of 2022, the team published research examining how artificial intelligence may be leveraged in the future to better distinguish benign and malignant nodules in pediatric patients.

“Currently, thyroid nodules are assessed by ultrasound, but nodule features cannot predict cancer with 100 percent certainty. Therefore, many patients need a biopsy or surgery to receive a definite diagnosis,” explains Page.

For patients, future findings could reduce the number of procedures required to achieve a diagnosis. Page says, “It’s exciting to see where this work will lead.”

On a national level, Page is actively involved in the Child & Adolescent Thyroid Consortium (CATC) and the American Thyroid Association (ATA).

“Through the CATC, about 20 pediatric thyroid cancer programs in North America are combining data. Working together, we’ll discover more about how pediatric thyroid cancer behaves.”

In addition, Page says her team will incorporate the ATA’s new pediatric thyroid cancer guideline recommendations, expected to be published later this year, into their management approach to continue providing the best possible patient care.