New Treatments for Pediatric Thyroid Disease
Dr. Kara Meister discusses new and developing treatments for pediatric thyroid diseases.
Featuring:
Kara Meister, MD
Dr. Kara Meister is a pediatric head and neck surgeon at SCH in the Children’s Thyroid Center. She specializes in the treatment of children with thyroid problems, thyroid cancer, and other tumors of the head & neck. Outside of LPCH, she is a wife, mom, and loves to hike, bike, and drink wine (though not at the same time!). Transcription:
Scott Webb: The Stanford Children's Health Pediatric Thyroid Center, one of the very few children's thyroid centers in the nation is focused on the treatment of children with thyroid conditions, including thyroid nodules and thyroid cancer. And joining me today to discuss the rise in thyroid problems in children, the latest research and data, and current and future treatment options is Dr. Kara Meister. She's a pediatric head and neck surgeon at Stanford Children's Health in the Children's Thyroid center.
This is Peds Talks from Stanford Children's health. I'm Scott Webb. Dr. Meister, it's so great to speak with you. I know thyroid problems seem to be increasing in children and teens. Is that true or is that just bad data?
Dr. Kara Meister: So, is it bad data? Is it true? We don't know. It's the million dollar question. So it does seem that starting in the mid-2000s, there has been a real increase in the incidence of thyroid cancer, particularly in our Hispanic teenage female population. Now, a lot of that data is based on the SEER Database. And California, which is where I am located, is a mandatory reporting state and so it's possible that it's biased data because we make up 60% of the SEER Database for this population. But in multiple sources, it does seem that there is an increase in papillary thyroid cancer, especially in our young Hispanic female.
Scott Webb: That's interesting, doctor. What were some of the most important publications in pediatric thyroid research over the past year?
Dr. Kara Meister: There have been a few since really the inaugural papers that we should know about. And it's not the past year. It's old now, which is 2015, but there's a new version on the horizon, which is Inaugural American Thyroid Association Guidelines for the management of nodules and cancer in pediatric patients. Since that publication in 2015, there's really been an explosion of literature in pediatric thyroidology.
About a year and a half ago, our team at Stanford Children's Health published the increased incidence data. And that was backed up by a similar study in Korea with similar findings of increased incidence. We're really just starting to understand what the horizon is for pediatric thyroid cancer. And in doing that, people have started to look at the genetics of these children and we see genetic mutations that are different in children than adults, which I'm hopeful will give us an insight as to what we see clinically.
Scott Webb: Yeah. It sounds like there is reason to be hopeful. And how have these new developments changed your approach to patient care? Or maybe they haven't, but assuming that they have, how have they?
Dr. Kara Meister: We really are taking a multidisciplinary approach. So every child that is treated in our center meets with pediatric endocrinology, our surgical teams, pediatric nuclear medicine. We're trying to understand what the role for radioactive iodine is in both children with malignancy and hyperthyroidism. They also all get to meet with a genetic counselor because increasingly we see that genetics plays a role even in benign thyroid disease. So that's how it's really changed my practice, is to making sure that children are offered that opportunity for families to meet with a genetic counselor and also a true multidisciplinary approach.
On the other side of things, there have been some really great innovations in clinical care. So we're doing things now that had not been done five years ago. Some of those are radiofrequency ablation of nodules, which is new to pediatric care, as well as scarless thyroid surgery, which is also new and likely has place here for our adult population as well as our adolescent and more mature child population.
Scott Webb: It's really fascinating. And, you know, understanding the role of genetics, as you've mentioned here is such a hot topic in so many areas of pediatric medicine. So what's the current conversation around genetics, thyroid problems in children? I think you've touched on it a little bit, but maybe we can touch on a few more.
Dr. Kara Meister: So the most important thing that we're trying to understand right now is how did the genetics influence clinical care and outcomes. So children do really well from thyroid cancer, which is fantastic. The 10 and 20-year survival rates are over 95% to 98%. So our goal is really to keep that excellent survival, but decrease side effects of treatment.
So we're trying to understand, do different mutations require more extensive surgery? Do they respond better to radioactive iodine? Can we save children from targeted chemotherapy? What can we learn about the genetics that will influence us to be minimalists? How can we be as minimalist as possible, save a child side effects of treatment, which hopefully they're going to live with for years and years to come, and can we learn about genetics in that context?
So we see some early publications that certain gene fusion mutations may have a more aggressive course. For example, if we do a more extensive surgery in children with fusion mutations, that may obviate the need for radioactive iodine. Those are the types of questions that we're looking at really in a multidisciplinary tertiary center.
Scott Webb: Yeah. And as you've discussed here today, there's plenty of reason for optimism about the future. So as we wrap up here, what's on the horizon? Like what's good, what's next?
Dr. Kara Meister: I think there are a lot of really exciting things going on in pediatric thyroid care. I touched on radiofrequency ablation that is definitely going to be here to stay. The role for pediatrics is evolving. But essentially, this is a non-surgical or minimally invasive procedure where we use a radiofrequency wand to ablate nodules.
In kids, I want to see two benign FNAs, so very low chance of cancer to no chance of cancer in this nodule and it needs to be in a certain location within the gland, but this is a great way to do organ preservation. Previously, if a kid had a nodule over a centimeter, we were requiring every six months, every 12 months ultrasounds. But the goal of radiofrequency is that we can treat that nodule and decrease the need for active surveillance, which is going to be huge, I think, for quality of life and resource management for these kids.
Scott Webb: You use the buzzwords there, minimally invasive, which I know we all want for ourselves and definitely our children. So doctor, this has been really educational today. Thank you so much for your time. And you stay well.
Dr. Kara Meister: Thanks. You too. Bye-bye.
Scott Webb: The Stanford Children's Health Pediatric Thyroid Centers, leading doctors and experts work as a team to diagnose, counsel and treat children and adolescents up to 18 years old. To learn more, go to thyroid.stanfordchildrens.org.
And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Peds Talks from Stanford Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.
Scott Webb: The Stanford Children's Health Pediatric Thyroid Center, one of the very few children's thyroid centers in the nation is focused on the treatment of children with thyroid conditions, including thyroid nodules and thyroid cancer. And joining me today to discuss the rise in thyroid problems in children, the latest research and data, and current and future treatment options is Dr. Kara Meister. She's a pediatric head and neck surgeon at Stanford Children's Health in the Children's Thyroid center.
This is Peds Talks from Stanford Children's health. I'm Scott Webb. Dr. Meister, it's so great to speak with you. I know thyroid problems seem to be increasing in children and teens. Is that true or is that just bad data?
Dr. Kara Meister: So, is it bad data? Is it true? We don't know. It's the million dollar question. So it does seem that starting in the mid-2000s, there has been a real increase in the incidence of thyroid cancer, particularly in our Hispanic teenage female population. Now, a lot of that data is based on the SEER Database. And California, which is where I am located, is a mandatory reporting state and so it's possible that it's biased data because we make up 60% of the SEER Database for this population. But in multiple sources, it does seem that there is an increase in papillary thyroid cancer, especially in our young Hispanic female.
Scott Webb: That's interesting, doctor. What were some of the most important publications in pediatric thyroid research over the past year?
Dr. Kara Meister: There have been a few since really the inaugural papers that we should know about. And it's not the past year. It's old now, which is 2015, but there's a new version on the horizon, which is Inaugural American Thyroid Association Guidelines for the management of nodules and cancer in pediatric patients. Since that publication in 2015, there's really been an explosion of literature in pediatric thyroidology.
About a year and a half ago, our team at Stanford Children's Health published the increased incidence data. And that was backed up by a similar study in Korea with similar findings of increased incidence. We're really just starting to understand what the horizon is for pediatric thyroid cancer. And in doing that, people have started to look at the genetics of these children and we see genetic mutations that are different in children than adults, which I'm hopeful will give us an insight as to what we see clinically.
Scott Webb: Yeah. It sounds like there is reason to be hopeful. And how have these new developments changed your approach to patient care? Or maybe they haven't, but assuming that they have, how have they?
Dr. Kara Meister: We really are taking a multidisciplinary approach. So every child that is treated in our center meets with pediatric endocrinology, our surgical teams, pediatric nuclear medicine. We're trying to understand what the role for radioactive iodine is in both children with malignancy and hyperthyroidism. They also all get to meet with a genetic counselor because increasingly we see that genetics plays a role even in benign thyroid disease. So that's how it's really changed my practice, is to making sure that children are offered that opportunity for families to meet with a genetic counselor and also a true multidisciplinary approach.
On the other side of things, there have been some really great innovations in clinical care. So we're doing things now that had not been done five years ago. Some of those are radiofrequency ablation of nodules, which is new to pediatric care, as well as scarless thyroid surgery, which is also new and likely has place here for our adult population as well as our adolescent and more mature child population.
Scott Webb: It's really fascinating. And, you know, understanding the role of genetics, as you've mentioned here is such a hot topic in so many areas of pediatric medicine. So what's the current conversation around genetics, thyroid problems in children? I think you've touched on it a little bit, but maybe we can touch on a few more.
Dr. Kara Meister: So the most important thing that we're trying to understand right now is how did the genetics influence clinical care and outcomes. So children do really well from thyroid cancer, which is fantastic. The 10 and 20-year survival rates are over 95% to 98%. So our goal is really to keep that excellent survival, but decrease side effects of treatment.
So we're trying to understand, do different mutations require more extensive surgery? Do they respond better to radioactive iodine? Can we save children from targeted chemotherapy? What can we learn about the genetics that will influence us to be minimalists? How can we be as minimalist as possible, save a child side effects of treatment, which hopefully they're going to live with for years and years to come, and can we learn about genetics in that context?
So we see some early publications that certain gene fusion mutations may have a more aggressive course. For example, if we do a more extensive surgery in children with fusion mutations, that may obviate the need for radioactive iodine. Those are the types of questions that we're looking at really in a multidisciplinary tertiary center.
Scott Webb: Yeah. And as you've discussed here today, there's plenty of reason for optimism about the future. So as we wrap up here, what's on the horizon? Like what's good, what's next?
Dr. Kara Meister: I think there are a lot of really exciting things going on in pediatric thyroid care. I touched on radiofrequency ablation that is definitely going to be here to stay. The role for pediatrics is evolving. But essentially, this is a non-surgical or minimally invasive procedure where we use a radiofrequency wand to ablate nodules.
In kids, I want to see two benign FNAs, so very low chance of cancer to no chance of cancer in this nodule and it needs to be in a certain location within the gland, but this is a great way to do organ preservation. Previously, if a kid had a nodule over a centimeter, we were requiring every six months, every 12 months ultrasounds. But the goal of radiofrequency is that we can treat that nodule and decrease the need for active surveillance, which is going to be huge, I think, for quality of life and resource management for these kids.
Scott Webb: You use the buzzwords there, minimally invasive, which I know we all want for ourselves and definitely our children. So doctor, this has been really educational today. Thank you so much for your time. And you stay well.
Dr. Kara Meister: Thanks. You too. Bye-bye.
Scott Webb: The Stanford Children's Health Pediatric Thyroid Centers, leading doctors and experts work as a team to diagnose, counsel and treat children and adolescents up to 18 years old. To learn more, go to thyroid.stanfordchildrens.org.
And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Peds Talks from Stanford Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.