Dr. Sajal Patel leads the Thyroid Nodule Clinic at Children’s of Alabama.
Pediatric endocrinologists at Children’s of Alabama are caring for children and adolescents with thyroid cancer in a leading-edge, multidisciplinary thyroid nodule clinic. Sajal Patel, M.D., and Nicole Barnes, M.D., take a multidisciplinary approach to assessing thyroid nodules and, if they are cancerous, managing them in conjunction with pediatric surgeons, nuclear medicine specialists and pathologists, along with their adult counterparts.
Thyroid cancer is rare in children, with a prevalence ranging from 4 to 5 per 100,000 compared with approximately 14.3 per 100,000 in adults. However, thyroid nodules in children are far more likely to be cancerous than in adults. The nodule clinic team meets regularly to review cases and optimize treatment plans. “This ensures that each patient receives the most suitable and personalized care,” Patel said.
The first step in treating thyroid cancer patients is surgery to remove all or part of the thyroid and any affected lymph nodes. This is followed, if needed, by radioactive iodine to destroy any remaining thyroid that may harbor small foci of cancer. After that comes continued surveillance through the clinic and management with thyroid hormone replacement.
“Thyroid cancer tends to be very slow spreading and localized, either within the thyroid or lymph nodes in the surrounding area,” Patel said. “It doesn’t typically metastasize.” For this reason, oncology is not a cornerstone of multidisciplinary thyroid cancer management. “When you need systemic treatments like immunotherapies or chemotherapy, then oncology gets pulled in.”
The disease typically manifests in the teenage years. When diagnosed in younger children, the team considers genetic cancer syndromes and does genetic testing to assess familial cancer risk. These syndromes include PTEN hamartoma tumor syndrome, DICER1 syndrome and multiple endocrine neoplasia syndrome. The team follows these cases closely, relying on pathology and genetics to analyze tissue samples and family histories.
The clinic is currently managing 10 to 15 children with thyroid cancer. The relatively large number of patients the clinic has followed over the years has contributed to a wealth of retrospective data, Patel said, which is vital given the rarity of the condition.
The clinic is involved in a collaborative project with Children’s Hospital of Philadelphia to establish a comprehensive thyroid cancer and nodule registry. The registry aims to provide long-term follow-up data, analyze treatment outcomes and gather information that can improve the care of pediatric thyroid cancer patients. “Currently, much of the knowledge in this field is derived from adult data,” Patel said, “making the need for dedicated pediatric research even more critical.”