Table 2.
Organization of the Pediatric Thyroid Nodule and Differentiated Thyroid Cancer Guidelines and Recommendations
| Location keya | Page | Section | Recommendation no. | Rating |
|---|---|---|---|---|
| [A1] | 720 | Why do we need specific guidelines for children with thyroid nodules and thyroid cancer? | ||
| [A2] | 720 | To what age group should these guidelines apply? | 1 | C |
| [A3] | 720–721 | Should treatment of children with DTC be stratified into more than one age group? | 2 | B |
| [A4] | 721–722 | What are the goals of therapy for DTC in children? | 3 | C |
| [B1] | 722 | Thyroid nodule guidelines | ||
| [B2] | 722 | How common are thyroid nodules in children and what is the risk for malignancy? | ||
| [B3] | 722–723 | Are there high-risk groups who might benefit from prospective screening for thyroid nodules and thyroid cancer? | 4(A) | B |
| 4(B) | I | |||
| 4(C) | C | |||
| 4(D) | B | |||
| [B4] | 723–725 | What is the optimal evaluation of children with thyroid nodules? | 5 | B |
| [B5] | 725 | Are there molecular signatures that complement FNA and improve the diagnostic tility of FNA in children? | 6 | E |
| [B6] | 725 | How should thyroid nodules be treated in children? | ||
| [B7] | 725 | What is the recommended approach for children with benign thyroid cytopathology? | ||
| [B8] | 725–726 | Is there a role for levothyroxine suppression therapy? | 7 | I |
| [B9] | 726 | Is there a role for surgery in children with benign nodules? | 8 | B |
| [B10] | 726 | What is the optimal management of the child with an autonomous thyroid nodule? | 9 | A |
| [C1] | 726 | Papillary thyroid cancer—initial management guidelines | ||
| [C2] | 726–727 | What is the optimal preoperative evaluation for the child with newly diagnosed PTC? | 10 | A |
| [C3] | 727 | What is the recommended surgical approach for the patient with a diagnosis of PTC? | 11 | A |
| [C4] | 727–728 | Should central neck dissection be performed? | 12(A) | B |
| 12(B) | C | |||
| 12(C) | A | |||
| 12(D) | C | |||
| [C5] | 728 | What are the indications for lateral neck dissection? | 13 | B |
| [C6] | 728–729 | What are the possible complications of surgery and what should be done to minimize the risks of surgery? | 14(A) | B |
| 14(B) | B | |||
| [C7] | 729–730 | What tumor classification systems can be used for pediatric PTC? | 15(A) | B |
| 15(B) | B | |||
| [C8] | 730–732 | What postoperative staging is recommended? | 16 | B |
| [C9] | 733 | What are the goals of 131I treatment? | ||
| [C10] | 733 | What is the impact of 131I therapy on recurrence and survival for children with PTC? | ||
| [C11] | 733 | Which children might benefit from therapeutic 131I? | 17 | B |
| [C12] | 733–734 | How should a child be prepared for 131I? | 18 | A |
| [C13] | 734–736 | What should be considered for administration of 131I? | 19(A) | C |
| 19(B) | F | |||
| [C14] | 736 | How is the activity of therapeutic 131I determined? | 20 | I |
| [C15] | 736 | Should a posttreatment whole-body scan be obtained? | 21 | B |
| [C16] | 736–737 | What are the acute and long-term risks of 131I therapy in children? | 22 | C |
| [D1] | 737 | Surveillance and follow-up of PTC In children | ||
| [D2] | 737–739 | What is the role of Tg testing in the follow-up of PTC in children? | 23(A) | A |
| 23(B) | A | |||
| 23(C) | B | |||
| 23(D) | A | |||
| 23(E) | A | |||
| [D3] | 739 | What is the role of ultrasound in the follow-up of PTC in children? | 24 | A |
| [D4] | 739–740 | How are diagnostic RAI scans best used in the follow-up of PTC in children? | 25(A) | C |
| 25(B) | B | |||
| 25(C) | B | |||
| [D5] | 740 | What imaging studies should be considered in the pediatric PTC patient who is Tg positive but who has no evidence of disease on cervical ultrasound or DxWBS? | 26(A) | B |
| 26(B) | D | |||
| 26(C) | D | |||
| [D6] | 740–741 | What are the goals and potential risks of TSH suppression therapy? | 27 | B |
| [D7] | 741 | What is the optimal approach to the patient with persistent / recurrent cervical disease? | 28(A) | C |
| 28(B) | B | |||
| 28(C) | B | |||
| 28(D) | C | |||
| [D8] | 741–742 | How should children with pulmonary metastases be managed? | 29(A) | A |
| 29(B) | B | |||
| 29(C) | B | |||
| 29(D) | B | |||
| 29(E) | E | |||
| 29(F) | C | |||
| [D9] | 742 | How does one approach the child with an incidental PTC identified after surgery for another thyroid condition? | 30 | B |
| [D10] | 742–743 | What are the optimal approaches to the pediatric patient who develops progressive thyroid cancer that no longer concentrates or responds to 131I? | 31 | C |
| [E1] | 743–744 | Follicular thyroid cancer | 32(A) | C |
| 32(B) | C | |||
| 32(C) | C | |||
| [F1] | 744 | What are the unique issues that may affect children diagnosed with DTC? | 33 | C |
| [G1] | 744–745 | How long should a child with PTC be monitored? | 34 | B |
| [G2] | 745 | What are the areas for future research? |
a
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DTC, differentiated thyroid cancer; DxWBS, diagnostic whole-body scan; FNA, fine-needle aspiration; PTC, papillary thyroid cancer; Tg, thyroglobulin; TSH, thyrotropin.