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Patient Information

thyroid noduleAt WakeMed Children’s, we bring together a comprehensive, multidisciplinary team to diagnose, treat and manage pediatric conditions of the thyroid glands. Patients and their families can be certain they will experience compassionate care centered on the age-appropriate needs of the child.

The WakeMed Children’s comprehensive Thyroid Center brings together multiple pediatric specialists, including Dr. Michael Ferguson (WakeMed ENT – Head & Neck Surgery), Dr. Mark Henin (WakeMed Children’s Endocrinology), Dr. David Hoover (WakeMed Children’s Pediatric Surgery) and Dr. Allen Marshall (WakeMed ENT – Head & Neck Surgery) to provide the best outcomes for each patient. Because each patient is different, their course of treatment may vary as well. Initial consultation for thyroid issues is provided by one of WakeMed Children’s Pediatric Endocrinologists. From there, the team will consult and refer to partnering pediatric specialists as needed for ongoing treatment and management.

What is the Thyroid?

The thyroid is a small, butterfly-shaped gland located at the base of the neck under the voice box. It is responsible for many functions within the body including metabolism, growth and development, temperature and energy regulation and more.

Thyroid Nodules and Their Causes

Pediatric thyroid nodules are abnormal, solid lumps or fluid-filled sacs (cysts) that form in a child’s thyroid. Thyroid nodules are rare in children, and the reason why thyroid nodules develop is largely unknown. However, family history of thyroid nodules and/or thyroid cancer or iodine deficiency increase risks of developing thyroid nodules.

Children may also have abnormalities unrelated to family history or iodine deficiency, such as:

  • A goiter—enlargement of the thyroid gland
  • Graves’ disease
  • Hashimoto’s disease

Signs of a Thyroid Nodule

Thyroid nodules are typically asymptomatic and pose no serious health risks. Because of that, thyroid nodules are a concern but do not pose an immediate need for treatment. Only a small percentage (fewer than 25%) are cancerous; thyroid cancer is a slow-moving cancer. However, as a parent, it’s important to have access to expert doctors as you seek care for your child.

Most pediatric thyroid nodules are discovered incidentally by a physician during a routine physical or scan used to uncover a different health problem.

In rare instances, thyroid nodules may become large enough to see, or they may press against the windpipe or esophagus disrupting swallowing and breathing.

If the nodule is overproducing thyroid hormone, called thyroxine, it may cause other symptoms in the body. These include:

  • Abnormal or rapid heartbeat
  • Anxiousness or irritability
  • Excessive sweating
  • Sudden weight loss
  • Tremors
  • Trouble sleeping


Once a physician discovers a thyroid nodule, the primary course of action is to determine if the nodule is benign (non-cancerous) or cancerous — treatment options are dependent upon the type of thyroid nodule.

If the nodule is benign, removal will depend on if the nodule is affecting breathing or swallowing or is sending too much thyroxine into the bloodstream. In most cases, the nodule is monitored through follow-up ultrasounds every few months.

For patients that travel some distance for their appointments at WakeMed Children’s, we strive to take care of these tests and visits all at once. For local patients, we try to accommodate your schedule when ordering these tests.

The treatment team will start by discussing the patients complete medical history and conducting an endocrine evaluation.

  • A physical exam of the thyroid nodule will help determine if it is firm or if there are abnormal lymph nodes.
  • Blood tests may help determine if normal amounts of thyroid hormone are being released into the blood stream. The provider will decide if these are necessary.
  • Fine needle aspiration (FNA) biopsy is performed via thyroid ultrasound. It is performed to gather cells to determine whether the nodule is cancerous

Should the thyroid nodule be cancerous or highly suspected of cancer, it is removed using a procedure called a thyroidectomy. A thyroidectomy is performed under general anesthesia using an endoscope to direct the surgeon to the gland. Nitrous Oxide is also available for younger patients that face anxiety prior to surgery. Over 90% of thyroid cancers in children are papillary thyroid cancer, and even when discovered in advanced stages, most children recover well.

The procedure takes about two to two-and-a-half hours. The incision is covered with a protective tape. Patients that have the entire thyroid removed will likely be hospitalized overnight and patients that have ½ of the thyroid removed will likely be discharged to recover at home that same day.


Surgery is generally well tolerated. Like any surgical incision, there will be some expected swelling, but typically children are back to speaking and eating immediately after surgery. Surgical recovery is quick though medical recovery is disease dependent.  As with most surgical procedures, recovery is dependent on the patient. Most can expect to make a full recovery in about a week. If the patient has Graves’ disease, there is a higher incidence of low calcium after surgery which may require a longer hospitalization.

Request a Referral

If you suspect your child has a thyroid issue, you can request a referral from your pediatrician. Your child will then be seen by Dr. Henin for diagnosis and treatment. Your process will also be guided by a caring patient navigator who will ensure you receive answers to your questions every step of the way.