Pediatric Management of Thyroid Nodules and Cancer: Summary of the American Thyroid Association’s Guideline

The American Thyroid Association (ATA) Task Force on Pediatric Thyroid Cancer has released management guidelines for children with thyroid nodules and differentiated thyroid cancer. Part 1 of this series describes the rationale for creating the pediatric guidelines and Parts 2 through 5 include a summary of the recommendations.

Previous guidelines from the American Thyroid Association (ATA) for evaluating and managing thyroid nodules and thyroid cancers targeted adults only. While thyroid neoplasia in childhood is associated with different pathophysiology, clinical presentation, and long-term outcomes than in adulthood, children with thyroid neoplasia were treated and followed according to the adult guidelines because no pediatric-specific guidelines were available.

Thus, previously all children with thyroid neoplasia were required to undergo total thyroidectomy and radioactive iodine ablation. Recent studies suggest that survivors of childhood differentiated thyroid cancer (DTC) are at increased risk for mortality, primarily because of malignancies in children treated with radiation. Thus, a primary goal in the development of the pediatric-specific guidelines was to help limit the use of aggressive radiation therapy in children who are unlikely to benefit.

Thyroid nodules are uncommon in children, but pose a greater risk for malignancy in the pediatric population than in the adult population (approximately 22%-26% vs 5%-10%). Disease specific mortality is low among children with DTC. Papillary thyroid cancer (PTC) accounts for 90% of thyroid cancer cases in children, with exposure of the thyroid to radiation being a major risk factor for development of PTC. Young children (<5 years of age) are the most sensitive to the effects of radiation.  

The recommendations are based on an extensive review of the medical literature related to clinical studies involving children and adolescents age ≤18 years, and cover all aspects of disease management, from preoperative staging to surgical management, the role of radioactive iodine therapy, and the goals of thyrotropin suppression. Because the vast majority of children with thyroid cancer have PTC, the guidelines were developed specifically for treatment of PTC and have a separate section for follicular thyroid cancer.

Access other summaries of the ATA's Pediatric Thyroid Cancer Guidelines:

July 14, 2015

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Pediatric Papillary Thyroid Cancer: ATA Recommendations 1-8
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