ATA Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer Guideline Summary

Key Points

The pediatric age should be limited to a patient ≤18 years of age. Establishing a uniform upper limit of age will afford an opportunity to better define the potential impact of growth on tumor behavior. From a pragmatic point of view, individual centers may transition pediatric patients to adult care anywhere between 18 and 21 years of age. Clinicians may manage the "child" under these guidelines until transition has been completed. ( C )

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Thyroid Nodules

Diagnosis

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 )

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Overview

Title

Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer