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Dell Children's new thyroid team to focus on thyroid cancers, issues in young patients

Veronica Lafuente, 14, has been through thyroid cancer.

Angela Lafuente thought there might be something concerning about her then-fourth grader. Veronica had started her period, and Lafuente worried that it was too soon and about how it might affect her daughter's growth.

"As a parent, I freaked out," she says.

Her daughter's doctor took Lafuente's concerns seriously even though Veronica was in what is considered a normal range for age at first period. 

As part of an exam, the pediatrician felt Veronica's neck and noticed an enlarged thyroid. 

That's when Veronica came under the care of doctors at Dell Children's Medical Center of Central Texas in what would become the new thyroid center.

The thyroid center isn't really a center; it's not located in one specific office space. Rather, it's head and neck surgeons, endocrinologists, interventional radiologists, radiologists, pathologists and other specialists all working together for shared patient care.  

"Really, the emphasis is on care and quality of care," said Dr. James Attra, a head and neck surgeon at Dell Children's who is part of the thyroid team. "Like many other programs, a team approach is being developed."

Dr. James Attra is a head and neck surgeon at Dell Children's Medical Center of Central Texas and part of the new thyroid team.

Veronica was diagnosed with Hashimoto's disease, an autoimmune disease that attacks the thyroid and can cause a thyroid that doesn't produce enough hormone. Veronica's only symptoms were her enlarged thyroid and the fact that she always "slept hot," her mom says, and would kick off the blankets at night. 

Veronica was monitored with routine blood tests to look at her thyroid levels and scans to see if anything was changing in the thyroid's size or physical appearance. 

Just before Thanksgiving 2019, when Veronica was in eighth grade, a scan detected a change. Spots on one side of her thyroid needed to be tested with a biopsy, which came back positive for cancer.

It was a bit shocking because, Veronica says, "I felt normal. I felt how I had always felt."

"Hearing that you have cancer is kind of a shock," Veronica says. "They did explain that this sort of cancer is not as deadly, but it was a shock."

If doctors had not been monitoring Veronica, "we would be in a totally different place," Lafuente says. The cancer would not have been caught so early.

Thyroid cancer often doesn't come with symptoms like other thyroid diseases. The giveaway is the size of the thyroid, Attra says. That's why pediatricians should feel their patients' necks, especially in adolescent girls, who are five times more likely than adolescent boys to be diagnosed with thyroid cancer. In children, the rates are the same between boys and girls. The good news is thyroid cancer has a 99 percent survival rate.

Attra talked the Lafuentes through possible treatments, which included removing part or all of the thyroid. Thyroid cancer in children has a 30 percent to 65 percent chance of reoccurring in the other lobe, Attra says, so often they will remove the whole gland. They also check to see if any of the surrounding lymph nodes in the neck have been impacted.

Veronica's cancer was contained in the thyroid. She had it removed at the beginning of January 2020. Her lymph nodes were not involved, so she did not need any other cancer treatments.

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That's also what's different about kids and thyroid cancer from adults. Some of the treatments that you might give adults could actually lead to more cancers during the long life of a pediatric thyroid cancer patient. That's part of the reason kids and adolescents should see a pediatric thyroid team instead of an adult team.

Now Veronica works with endocrinology within the thyroid program to manage her thyroid hormone medically because she no longer produces the hormone on her own. She will take synthetic thyroid medications for the rest of her life. 

Her doctors have explained why taking her medication regularly is important. Without the thyroid hormone, she could experience weight gain and fatigue and ultimately could go into a coma. Regularly monitoring her medication is also important. If she got too much medication, she could become jittery and experience uncontrolled weight loss. 

Creating this thyroid team allows Attra and his colleagues to better share patient care. They treat a variety of thyroid diseases including Hashimoto's; Graves' disease, which pumps out too much thyroid hormone; benign nodules; and cancers.

"It's the same people taking care of the same things," he says. "It's knowing who to go to, to provide high-quality care." 

Most of their referrals are coming from pediatricians doing the routine exam of feeling a patient's neck, just like they would listen to the heart or feel the belly. 

Veronica Lafuente, 14,  will continue to be monitored by the thyroid team at Dell Children's to make sure she has enough hormones in her body through medication.

Nicole Villalpando writes about parenting for the American-Statesman. She can be reached at nvillalpando@statesman.com.