We report on nine children, 9 to 17 years of age, with papillary carcinoma of the thyroid, whereby eight of them had lymph node metastases, and four had diffuse pulmonary metastases. After total thyroidectomy and up to four cycles of radioiodine treatment, as well as surgical resection of metastases negative to radioactive iodine uptake, there was no evidence of relapsing disease in any of the children. Hence, taking into consideration and optimal tumor patient follow-up and the improvement of the long-term prognosis, we recommended total thyroidectomy, also for encapsulated, well-differentiated thyroid carcinomas.