Table 6.

American Thyroid Association Pediatric Thyroid Cancer Risk Levels and Postoperative Management in Children with Papillary Thyroid Carcinoma

ATA pediatric risk levela	Definition	Initial postoperative stagingb	TSH goalc	Surveillance of patients with no evidence of diseased
Low	Disease grossly confined to the thyroid with N0/Nx disease or patients with incidental N1a disease (microscopic metastasis to a small number of central neck lymph nodes)	Tge	0.5–1.0 mIU/L	US at 6 months postoperatively and then annually × 5 years Tge on LT4 every 3–6 months for 2 years and then annually
Intermediate	Extensive N1a or minimal N1b disease	TSH-stimulated Tge and diagnostic 123I scan in most patients (see Fig. 2)	0.1–0.5 mIU/L	US at 6 months postoperatively, every 6–12 months for 5 years, and then less frequently Tge on LT4 every 3–6 months for 3 years and then annually Consider TSH-stimulated Tge ± diagnostic 123I scan in 1–2 years in patients treated with 131I
High	Regionally extensive disease (extensive N1b) or locally invasive disease (T4 tumors), with or without distant metastasis	TSH-stimulated Tge and diagnostic 123I scan in all patients (see Fig. 2)	<0.1 mIU/L	US at 6 months postoperatively, every 6–12 months for 5 years, and then less frequently Tge on LT4 every 3–6 months for 3 years and then annually TSH-stimulated Tge ± diagnostic 123I scan in 1–2 years in patients treated with 131I

Please refer to Table 5 for AJCC TNM classification system.

^a“Risk” is defined as the likelihood of having persistent cervical disease and/or distant metastases after initial total thyroidectomy ± lymph node dissection by a high volume thyroid surgeon and is not the risk for mortality, which is extremely low in the pediatric population. See Section C7 for further discussion.

^bInitial postoperative staging that is done within 12 weeks after surgery.

^cThese are initial targets for TSH suppression and should be adapted to the patient's known or suspected disease status; in ATA Pediatric Intermediate- and High-risk patients who have no evidence of disease after 3–5 years of follow-up, the TSH can be allowed to rise to the low normal range.

^dPostoperative surveillance implies studies done at 6 months after the initial surgery and beyond in patients who are believed to be disease free; the intensity of follow-up and extent of diagnostic studies are determined by initial postoperative staging, current disease status, and whether or not ¹³¹I was given; may not necessarily apply to patients with known or suspected residual disease (see Fig. 3) or FTC.

^eAssumes a negative TgAb (see Section D2); in TgAb-positive patients, consideration can be given (except in patients with T4 or M1 disease) to deferred postoperative staging to allow time for TgAb clearance.

ATA, American Thyroid Association; LT₄, levothyroxine; TgAb, thyroglobulin antibody; US, ultrasound.