Neck lumps in children: focus on the thyroid

Neck lumps in children: focus on the thyroid

By Robert L. Weinsheimer, MD
Pediatric General Surgeon

There are a wide variety of nodules or lumps of the neck. We often group these growths by their location. While many lumps are simply lymph nodes, which come and go, growths near the “Adam’s apple” merit special attention. Lumps in the front/center of the neck are most likely related to the thyroid gland.

The thyroid gland produces thyroid hormone ,which is a chemical that influences a wide range of the body’s functions such as digestion, heart rate, mood, appetite, temperature, and growth. Younger children tend to have a congenital remnant called a thyroglossal duct cyst. During fetal development, the thyroid gland originates from the base of the tongue and then descends down the front of the neck to its eventual home just below the “Adam’s apple.” These cysts often get infected because they maintain a connection to the throat allowing bacteria to enter. If infected, we treat these initially with antibiotics and then perform a surgery to remove the cyst and its connection. The procedure is typically performed as a day surgery.

Actual thyroid nodules are increasing in number with an estimate around 1% of children developing an abnormal thyroid growth. These can vary from not at all threatening to cancerous (malignant). Firm, solid nodules that grow over time tend to be more concerning; but regardless of how they feel, these lumps should be evaluated by your physician. Sometimes the nodules cause an overactive thyroid gland which can lead to symptoms such as: feeling warmer than others, rapid or irregular pulse, anxiety/nervousness, insomnia, tremor, weight loss. Other times the nodule due to its size may cause symptoms such as pain, hoarse voice, difficulty swallowing.

Evaluation of these nodules includes a thorough history and physical examination, ultrasound, and laboratory tests. A pediatric endocrinologist typically coordinates this evaluation, and if needed, a sample of the nodule is obtained using a small needle (fine needle aspirate or “FNA”). Depending on the level of suspicion for cancer, nodules can either be closely observed, or they may need to be removed by surgery. Surgery typically involves removal of one side of the thyroid gland. The other half of the gland is only removed if the nodule demonstrates evidence of cancer. Thankfully, the vast majority of children diagnosed with thyroid cancer do well.

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