FIG. 1.

Initial evaluation, treatment, and follow-up of the pediatric thyroid nodule. ¹Assumes a solid or partially cystic nodule ≥1 cm or a nodule with concerning ultrasonographic features in a patient without personal risk factors for thyroid malignancy (see Sections B3 and B4). ²A suppressed TSH indicates a value below the lower limits of normal. ³Refer to PTC management guidelines (Section C1) or MTC management guidelines. ⁴Surgery can always be considered based upon suspicious ultrasound findings, concerning clinical presentation, nodule size >4 cm, compressive symptoms, and/or patient/family preference. ⁵Surgery implies lobectomy plus isthmusectomy in most cases. Surgery may be deferred in patients with an autonomous nodule and subclinical hyperthyroidism, but FNA should be considered if the nodule has features suspicious for PTC. (See Section B10.) Consider intraoperative frozen section for indeterminate and suspicious lesions. Can consider total thyroidectomy for nodules suspicious for malignancy on FNA. ⁶Consider completion thyroidectomy ± RAI versus observation ± TSH suppression based upon final pathology (see Section E1).