Thyroid Center | Research & Innovation

The Thyroid Center at Boston Children’s Hospital remains the country’s most prolific research group for studies that increase the understanding of pediatric thyroid function and disease. In particular, our investigators are leading the charge in the study of childhood thyroid nodules. For example, our research suggests that adult systems for thyroid nodule evaluation, which have long been applied directly to children, require modifications to work optimally in a pediatric population. These and other findings are changing the way clinicians care for patients with pediatric thyroid disease.

Some of our key research findings include:

Thyroid nodules and cancer

• Certain features of thyroid cancer may help guide which children can be treated with more limited surgery to reduce surgical risk and need for thyroid medication. Cherella CE, Richman DM, Liu E, Frates MC, Modi BP, Zendejas B, Smith JR, Barletta JA, Hollowell ML, Wassner AJ. Predictors of Bilateral Disease in Pediatric Differentiated Thyroid Cancer. J Clin Endocrinol Metab. 2021 Mar 29:dgab210. doi: 10.1210/clinem/dgab210. Epub ahead of print. PMID: 33780538.
• Describing when thyroid nodules develop and how they progress in children with PTEN syndrome. Smith JR, Liu E, Church AJ, Asch E, Cherella CE, Srivastava S, Kamihara J, Wassner AJ. Natural History of Thyroid Disease in Children with PTEN Hamartoma Tumor Syndrome. J Clin Endocrinol Metab. 2021 Mar 8;106(3):e1121-e1130. doi: 10.1210/clinem/dgaa944. PMID: 33347563.
• A widely used ultrasound system for assessing risk of cancer in adults with thyroid nodules may miss a significant percentage of thyroid cancers in children. Richman DM, et al. Radiology. 2019.
• Children have a higher risk of cancer pediatric thyroid nodules than adults, even if the nodules have identical findings on initial evaluation. This implies some potential differences in how the standard cytology system (developed in adults) is applied to children. Cherella CE, et al. Thyroid. 2019 Aug;29(8):1097-1104
• Thyroid nodules in children that are benign by biopsy are very unlikely to be cancerous. However, a few of these nodules may still harbor slow-growing thyroid cancers, so they should be followed by ultrasound yearly to make sure they do not grow or change. Cherella CE, et al. J Clin Endocrinol Metab. 2018 Sep 1;103(9):3557-356
• The largest published study demonstrating which ultrasound characteristics increase the risk of thyroid cancer in children with thyroid nodules. Richman DM, et al. Radiology. 2018 Aug;288(2):591-599.
• Autonomous (overactive) thyroid nodules in children, like in adults, are usually benign. Ly S, et al. J Clin Endocrinol Metab. 2016;101:3856-62
• A team with experience performing thyroid ultrasounds and biopsies in children can successfully diagnose thyroid cancer while avoiding unnecessary thyroid surgery in children who do not need it. Gupta A, et al. J Clin Endocrinol Metab 2013;98:3238-45
• Thyroid biopsies can be done safely and without sedation in almost all children. Gupta A, et al. J Clin Endocrinol Metab 2013;98:3238-45
• An experienced pediatric thyroid surgery team can perform thyroid surgery with a low risk of complications similar to that of high-volume adult thyroid surgeons. Scholz S, Smith JR, et al. J Pediatr Surg. 2011;46:437-42
• Children with thyroid cancer can be prepared for radioactive iodine therapy by stopping their thyroid medication for a short 2-week period. Kujit WJ & Huang SA. J Clin Endocrinol Metab. 2005;90:6123-5

Hypothyroidism

• Mild hypothyroidism does not affect outcomes in children undergoing heart surgery, and delaying surgery is usually not necessary. Brown ML, Quinonez LG, Staffa SJ, DiNardo JA, Wassner AJ. Relationship of Preoperative Thyroid Dysfunction to Clinical Outcomes in Pediatric Cardiac Surgery. J Clin Endocrinol Metab. 2021 Apr 23;106(5):e2129-e2136. doi: 10.1210/clinem/dgab040. PMID: 33492396.
• Update on congenital hypothyroidism Cherella CE & Wassner AJ. Curr Opin Endocrinol Diabetes Obes. 2019;11
• The first report of hypothyroidism in infants exposed to a new form of iodinated contrast used in radiology studies. Cherella CE, et al. J Clin Endocrinol Metab. 2018 Oct 1;103(10):3585-3588.
• Liothyronine may improve thyroid function tests in certain patients with congenital hypothyroidism. Paone L, et al. J Pediatr. 2016;175:167-72
• Hypothyroidism caused by too much iodine may be more common in infants born with heart disease than previously thought. Thaker VV, et al. J Clin Endocrinol Metab. 2014;99:3521-6
• Generic and brand-name levothyroxine (thyroid hormone) may not be equivalent for children with severe congenital hypothyroidism. Carswell JM, et al. J Clin Endocrinol Metab. 2013;98:610-7
• Central hypothyroidism can be the first sign of PROP1 deficiency in children. Wassner AJ, et al. Horm Res Paediatr. 2013;79:379-86
• Diets of hospitalized preterm infants may not contain enough iodine. Belfort MB, et al. J Clin Endocrinol Metab. 2012 Apr;97:E632-6
• Discovery of a new form of hypothyroidism in children. Huang SA, et al. N Engl J Med. 2000;343:185-9

Hyperthyroidism

• Discovery that the common antibiotic minocycline can cause thyroiditis. Millington K, et al. Horm Res Paediatr. 2019 Sep 18:1-8.
• Pediatric Graves' disease: decisions regarding therapy. Okawa ER, Grant FD, Smith JR. Curr Opin Pediatr. 2015 Aug;27:442-7
• Discovery of new genetic factors associated with early onset of Graves’ disease. Brown RS, et al. J Clin Endocrinol Metab. 2014;99:E1387-91
• TSH receptor antibodies last longer in children than in adults with Graves’ disease, and their level does not predict how patients respond to treatment. Smith JR & Brown RS. Thyroid. 2007;17:1103-7