Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer

The evaluation and treatment of thyroid nodules in children (Figure 1) should be the same as in adults with the exceptions that:

• US characteristics and clinical context should be used rather than size alone to identify nodules that warrant FNA.
• All FNA in children should be performed under US-guidance.
• Preoperative FNA of a hyperfunctioning nodule in a child is not warranted as long as the lesion is removed.
• A diffusely infiltrative form of PTC may occur in children and should be considered in a clinically suspicious gland.
• Surgery (lobectomy + isthmusectomy) is favored over repeat FNA for most nodules with indeterminate cytology.

( B )

A positive mutational test appears highly likely to be associated with malignancy. Conversely, insufficient data exist in children to rely on negative genetic studies to reliably exclude malignancy. Although molecular studies hold promise for complementing the results of FNA, particularly for nodules that yield indeterminate cytology, they have not yet been sufficiently validated in children and cannot be routinely recommended in routine clinical practice until further studies are conducted. ( E )

For patients with autoimmune thyroiditis, evaluation by an experienced thyroid ultrasonographer should be pursued in any patient with a suspicious thyroid examination (suspected nodule or significant gland asymmetry), especially if associated with palpable cervical lymphadenopathy. ( B )