FIG. 2.

Initial postoperative staging for American Thyroid Association pediatric intermediate- and high-risk pediatric thyroid carcinoma. ¹Assumes a negative TgAb (see Section D2) and a TSH >30 mIU/L; in TgAb-positive patients, consideration can be given (except in patients with T4 tumors or clinical M1 disease) to deferred evaluation to allow time for TgAb clearance (“delayed” staging). ²Imaging includes neck ultrasonography ± SPECT/CT at the time of the diagnostic thyroid scan. ³Consider ¹³¹I in patients with thyroid bed uptake and T4 tumors or known residual microscopic cervical disease. ⁴While there are no prospective studies in patients ≤18 years of age, the use of ¹³¹I remnant ablation may not decrease the risk for persistent or recurrent disease. Consider surveillance rather than ¹³¹I with further therapy determined by surveillance data. ⁵Repeat postoperative staging 3–6 months after surgery. ⁶See Table 6 and Figures 3 and 4.