Thyroid cancer Q&A: The unique needs of adolescents and young adults

Sept. 22, 2022

Mayo Clinic endocrinologist M. Regina Castro, M.D., explains that thyroid cancer is one of the most common cancers diagnosed in patients between the ages of 15 and 29, also referred to as adolescents and young adults (AYAs). Dr. Castro answers questions about the unique concerns for AYAs with thyroid cancer.

How does thyroid cancer in AYAs compare with the disease in other age groups?

In this age group, thyroid cancer tends to be more advanced upon presentation than in older adults, meaning that there is a higher frequency of the tumor having spread outside of the thyroid. It also has a higher rate of recurrence. Despite all this, the prognosis for survival in children and adolescents is excellent and generally better than in older adults.

What unique thyroid cancer concerns exist for this population?

Even when the prognosis is excellent, many AYAs need to have surgery and take a thyroid hormone pill for the rest of their lives. Finding the right dose can take some time. In many patients, and particularly in those with more-advanced disease or frequent recurrences, we aim to keep thyroid-stimulating hormone (TSH) suppressed. This can have long-term effects as these patients get older, such as increased risk of bone loss.

Although rare when surgery is performed by experienced surgeons at tertiary care centers, some patients may experience complications related to surgery. They also will have to live with a surgical scar visible in the neck, which can result in body image concerns. Because they are diagnosed at a young age, AYAs need long-term monitoring with annual visits to their endocrinologists for many years.

What type of care team is most effective in treating thyroid cancer for AYAs?

Surgery is key and one of the most important treatments for thyroid cancer. Doing the most thorough surgery to remove all or as much as possible of the tumor and any affected lymph nodes gives AYAs the best chance for a cure. To accomplish this, we need a multidisciplinary team including the endocrinologist who will coordinate care, a very good radiology team with expertise in neck imaging, especially ultrasound, an experienced surgeon and nurses, and in some cases a nuclear medicine doctor, if the patient needs radioiodine treatment.

This multidisciplinary effort requires all members of the team to be engaged and provide each one's perspective and expertise for the best chances of a successful treatment. I could be the best endocrinologist in the world, but if I don't have a good radiology team to get a good preoperative assessment and an excellent, experienced surgeon to do the operation with very low risk of complications, all my knowledge may not be sufficient to help my patient get the best treatment. In many places, such complex care and multidisciplinary teams are not available.

It is important for these patients to be examined at tertiary care facilities for their treatment early on, before surgery is done. An interesting fact is that most thyroidectomies in the U.S. are performed by surgeons who do fewer than 10 of these surgeries each year. Ideally, such surgeries should be performed by surgeons who do a minimum of 25 to 30 of these surgeries each year. The risk of complications is inversely related to the experience of the surgeon. In addition to experienced surgeons, tertiary care centers typically have multidisciplinary teams and many more resources to deal with the more difficult situations.

What advancements have been made in thyroid cancer treatment and supporting AYAs through survivorship?

In the past, all young patients with thyroid cancer would be treated with total thyroidectomy, particularly in young adults because of the disease presenting in a more advanced stage. Now with better imaging technology, it is often possible to determine if a patient has less advanced disease. In those patients, there is a trend to be less aggressive with treatment by offering a lobectomy instead of a total thyroidectomy. These patients with smaller and lower risk tumors will not typically need radioactive iodine.

At Mayo Clinic, we also have a thyroid cancer survivorship clinic, where we send patients who have had surgery. Patients visit with a provider and discuss goals, long-term management plans, expectations and more. Staff at the clinic assist patients who may need additional support and present patients with their plans so that even those who get care locally will understand their thyroid cancer management and follow-up.

For more information

Refer a patient to Mayo Clinic.