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Duke Pediatric Comprehensive Thyroid Clinic Opens

Thursday, October 18, 2018
Laura Page; Michael Freemark

Duke Children’s and the Division of Pediatric Endocrinology are excited to announce the opening of the Duke Pediatric Comprehensive Thyroid Clinic. Co-directed by Michael Freemark, MD, Robert C. Atkins, MD and Veronica Atkins Professor of Pediatrics and chief of the Division of Pediatric Endocrinology, and Laura Page, MD, assistant professor of pediatrics, the clinic is dedicated to providing expert, comprehensive, and compassionate care for children and adolescents with thyroid nodules and thyroid cancer. Additionally, the clinic follows children and teenagers at increased risk for thyroid cancers because of a family history of thyroid cancer, a genetic condition predisposing to thyroid cancer, or a history of radiation exposure to the neck. The clinic has a multidisciplinary approach with involvement of endocrine and pediatric surgeons and pediatric radiology, as well as colleagues in genetics, ophthalmology, otolaryngology, oncology, and anesthesiology.

The clinic is one of few nationwide that specializes in pediatric surgical thyroid problems and offers a streamlined referral process by which one call reaches the entire team. Drs. Freemark and Page have extensive experience in the management of thyroid disorders in children and place an emphasis on continuing care for Duke pediatric thyroid cancer patients even after they enter remission.

While uncommon, the incidence of thyroid cancer in children, adolescents, and young adults is increasing (estimates of the annual percentage change in incidence vary from approximately 1-3% per year). Importantly, this rise is not attributable to greater detection of very small tumors as the incidence of large tumors (greater than or equal to 1 cm) has also increased. Thyroid nodules found in children have a higher risk of malignancy compared to adults. Further, in children, thyroid cancer appears to progress differently than in adults, with children having increased likelihood of lymph node metastases and distant metastases. Despite this, thyroid cancer in children has an excellent prognosis with a 2% or less long-term, cause-specific mortality. For these reasons, it is important that children with thyroid nodules and thyroid cancer be treated according to pediatric-specific guidelines. These differences also highlight the need for additional research related to pediatric thyroid nodules and cancer.

Radiation exposure puts a child at increased risk of developing thyroid cancer, particularly if the exposure occurs when the child is less than 5-10 years old. The relationship between thyroid cancer risk and radiation dose is curvilinear with a peak relative risk of 14.6 fold increased risk. Estimates suggest that in North America, more than 1500 pediatric oncology patients are treated annually with radiation therapy. Thus, there is a large, vulnerable population of children who warrant close follow up and expert care if a thyroid nodule is discovered.

Research also shows that high-volume thyroid surgeons--those performing greater than 25 thyroidectomies per year--have decreased complication rates compared to low-volume thyroid surgeons. Randall Scheri, MD, associate professor of surgery and chief of the Section of Endocrine Surgery, has more than 12 years of experience and performs more than 300 thyroidectomies each year. Tamara Fitzgerald, MD, PhD, FACS, FAAP, is a pediatric surgeon with a special interest in pediatric endocrine surgery. During her surgical training at Yale University, she served as chief resident on the endocrine surgery service, which is a high-volume center receiving national and international referrals. She continued her training in pediatric endocrine surgery as the pediatric surgery fellow at this same institution. Before coming to Duke, she worked closely with pediatric endocrinologists in Texas to provide surgical care to children on the US-Mexico border. The combined expertise of these surgeons ensures the best possible surgical outcomes for patients.

Please contact Michael Freemark at michael.freemark@duke.edu or Laura Page at laura.page@duke.edu for additional information. For appointments/referrals, call 919.684.8361.