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Thyroid. 2015 Jul;25(7):716-59. doi: 10.1089/thy.2014.0460.

Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer.

Author information

1 Division of Pediatric Endocrinology, Virginia Commonwealth University , Children's Hospital of Richmond, Richmond, Virginia.
2 Department of Endocrine Neoplasia and Hormonal Disorders and Department of Pediatrics-Patient Care, Children's Cancer Hospital, University of Texas MD Anderson Cancer Center , Houston, Texas.
3 Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania.
4 Department of Pediatrics, The University of Pennsylvania , The Perelman School of Medicine, Philadelphia, Pennsylvania.
5 Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine , Chicago, Illinois.
6 University of Messina , Interdepartmental Program on Clinical & Molecular Endocrinology, and Women's Endocrine Health, A.O.U. Policlinico Universitario G. Martino, Messina, Italy .
7 Department of Morphology and Genetics. Division of Genetics, Federal University of São Paulo , São Paulo, Brazil .
8 Department of Surgery, Division of Pediatric Surgery, Department of Pediatrics, Division of Pediatric Endocrinology, Yale University School of Medicine , New Haven, Connecticut.
9 Division of Endocrinology, University of Toronto , Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada .
10 Division of Endocrinology, Mayo Clinic and College of Medicine , Rochester, Minnesota.
11 University of Marburg , Marburg, Germany .
12 Department of Nuclear Medicine, University Hospital Marburg , Marburg, Germany .
13 Departments of Radiology and Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital , Department of Radiology, Seattle, Washington.
14 Pediatric Division, Assaf Haroffeh Medical Center , Zerifin, Israel .
15 Sackler School of Medicine, Tel Aviv University , Tel Aviv, Israel .
16 Department of Surgery, Division of Subspecialty GS (General Surgery), Mayo Clinic , Rochester, Minnesota.
17 Atomic Bomb Disease Institute, Nagasaki University , Nagasaki, Japan .



Previous guidelines for the management of thyroid nodules and cancers were geared toward adults. Compared with thyroid neoplasms in adults, however, those in the pediatric population exhibit differences in pathophysiology, clinical presentation, and long-term outcomes. Furthermore, therapy that may be recommended for an adult may not be appropriate for a child who is at low risk for death but at higher risk for long-term harm from overly aggressive treatment. For these reasons, unique guidelines for children and adolescents with thyroid tumors are needed.


A task force commissioned by the American Thyroid Association (ATA) developed a series of clinically relevant questions pertaining to the management of children with thyroid nodules and differentiated thyroid cancer (DTC). Using an extensive literature search, primarily focused on studies that included subjects ≤18 years of age, the task force identified and reviewed relevant articles through April 2014. Recommendations were made based upon scientific evidence and expert opinion and were graded using a modified schema from the United States Preventive Services Task Force.


These inaugural guidelines provide recommendations for the evaluation and management of thyroid nodules in children and adolescents, including the role and interpretation of ultrasound, fine-needle aspiration cytology, and the management of benign nodules. Recommendations for the evaluation, treatment, and follow-up of children and adolescents with DTC are outlined and include preoperative staging, surgical management, postoperative staging, the role of radioactive iodine therapy, and goals for thyrotropin suppression. Management algorithms are proposed and separate recommendations for papillary and follicular thyroid cancers are provided.


In response to our charge as an independent task force appointed by the ATA, we developed recommendations based on scientific evidence and expert opinion for the management of thyroid nodules and DTC in children and adolescents. In our opinion, these represent the current optimal care for children and adolescents with these conditions.

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