# Thyroid Cancer — GCMD Library living collection

Everything in the library about thyroid cancer — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 69 cited statements

## Episodes
### Surgical Management
- [Update Course Rewind 2025: Nerve Monitoring in Pediatric Thyroid Surgery](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577) — video · 6:20 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577.md)
- [Nerve monitoring and risk stratification in pediatric thyroid surgery](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844) — podcast · 6:20 · [machine version](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844.md)

### In-Depth Reviews
- [Thyroid Disorders](https://library.globalcastmd.com/watch/thyroid-disorders-302) — podcast · 45:51 · [machine version](https://library.globalcastmd.com/watch/thyroid-disorders-302.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=0) Introduction and Background (Ep 1)
- [2:29](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=149) Initial Evaluation of Thyroid Nodules (Ep 1)
- [6:56](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=416) Laboratory and Imaging Workup (Ep 1)
- [9:26](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=566) Ultrasound Characteristics and Biopsy Criteria (Ep 1)
- [11:40](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=700) FNA Technique and Papillary Cancer Diagnosis (Ep 1)
- [14:17](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=857) Surgical Management of Papillary Thyroid Cancer (Ep 1)
- [17:40](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1060) Postoperative Management and Risk Stratification (Ep 1)
- [21:48](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1308) Follicular Lesions and Indeterminate Cytology (Ep 1)
- [24:39](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1479) Frozen Section and Follicular Cancer Management (Ep 1)
- [27:53](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1673) Benign Nodules and Inadequate Specimens (Ep 1)
- [30:08](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1808) Medullary Thyroid Cancer: Initial Workup (Ep 1)
- [35:20](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2120) MEN Syndromes and Prophylactic Thyroidectomy (Ep 1)
- [39:27](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2367) Medullary Cancer: Postoperative Management (Ep 1)
- [41:59](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2519) Graves' Disease and Diffuse Papillary Cancer (Ep 1)
- [44:23](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2663) Closing Remarks (Ep 1)
- [0:01](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=1) Case Presentation and Initial Management of Pediatric Thyroid Nodule (Ep 2)
- [2:07](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=127) Intraoperative Nerve Monitoring: Evidence and Application (Ep 2)
- [4:28](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=268) Technical Considerations and Modified TIRRADS for Pediatrics (Ep 2)
- [5:42](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=342) Summary and Clinical Recommendations (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=0) Case presentation and initial management of indeterminate thyroid nodule (Ep 3)
- [1:07](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=67) Surgical approach and surgeon selection for pediatric thyroid nodules (Ep 3)
- [2:07](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=127) Intraoperative nerve monitoring technique and evidence (Ep 3)
- [4:40](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=280) Modified TIRADS criteria for pediatric populations (Ep 3)
- [5:45](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=345) Summary of key recommendations (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Thyroid nodules are less common in children than adults, but when detected in children, they are more likely to be malignant. — Diana Deason (epidemiological) [Ep 1 · 6:23](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=383)
- When children present with thyroid cancer, they are more likely to have extension outside of the thyroid, regional lymph node involvement, and distant metastasis compared to adults. — Diana Deason (clinical) [Ep 1 · 6:31](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=391)
- Risk factors for thyroid nodules and cancer include previous exposure to radiation or alkylating agents, such as treatment for Hodgkin's lymphoma, leukemia, or CNS tumors. — Diana Deason (clinical) [Ep 1 · 4:08](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=248)
- Some thyroid conditions and thyroid cancers have familial predisposition, including MEN syndromes, PTEN hamartoma tumor syndromes, and APC-associated polyposis syndromes. — Diana Deason (clinical) [Ep 1 · 4:27](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=267)
- If TSH is suppressed, a nuclear thyroid scan should be obtained to identify hyperfunctioning nodules, which do not need to be biopsied if they are going to be resected. — Diana Deason (guideline) [Ep 1 · 7:24](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=444)
- Suspicious ultrasound features for thyroid malignancy include hypoechoic mass, irregular margins, increased blood flow, microcalcifications, or association with abnormal lymph nodes. — Diana Deason (clinical) [Ep 1 · 9:57](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=597)
- In pediatric patients, size cutoffs used in adults (1 cm) cannot be applied for biopsy decisions; ultrasound characteristics and clinical context determine whether FNA is warranted. — Diana Deason (guideline) [Ep 1 · 11:21](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=681)
- Total or near-total thyroidectomy is recommended for papillary thyroid cancer due to risk of bilateral disease (up to 30%), multifocal disease (up to 65%), increased risk of recurrence with lobectomy alone, and ability to optimize for radioactive iodine and use thyroglobulin as a tumor marker. — Diana Deason (guideline) [Ep 1 · 15:00](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=900)
- Nerve monitoring is used routinely during thyroidectomy, and while it does not decrease the risk of nerve injury, it is helpful in identifying the recurrent laryngeal nerve, especially in patients with bulky cervical disease. — Diana Deason (opinion) [Ep 1 · 17:07](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1027)
- There is no evidence to support prophylactic lateral neck dissection in thyroid cancer; lateral neck dissection is performed only when lateral nodes are pathologically positive. — Diana Deason (guideline) [Ep 1 · 18:33](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1113)
- After total thyroidectomy, PTH levels less than 10 to 15 in recovery indicate higher risk for hypocalcemia, prompting initiation of calcium replacement or calcitriol. — Diana Deason (clinical) [Ep 1 · 19:37](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1177)
- Low-risk papillary thyroid cancer patients (disease confined to thyroid, no nodal involvement, T1B N0) require only thyroglobulin surveillance with TSH suppression to 0.5-1, ultrasound at 6 months postoperatively, then annually for 5 years. — Diana Deason (guideline) [Ep 1 · 21:12](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1272)
- Intermediate-risk patients (extensive central neck disease or any lateral neck disease) and high-risk patients (extensive regional disease, local invasion, or distant metastases) may require radioactive iodine postoperatively. — Diana Deason (guideline) [Ep 1 · 21:48](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1308)
- Follicular lesions represent about one-third of thyroid FNA results and are indeterminate specimens. — Diana Deason (epidemiological) [Ep 1 · 23:05](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1385)
- For follicular lesions of undetermined significance, the risk of malignancy in adults is 5-15%, but in pediatric literature it is approximately 28%. — Diana Deason (epidemiological) [Ep 1 · 24:07](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1447)
- For follicular neoplasms, the reported malignancy rate was 15-30%, but more recent data suggests it is between 50% and 60% in children. — Diana Deason (epidemiological) [Ep 1 · 24:18](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1458)
- Current ATA recommendations are that all indeterminate (follicular) lesions in children be resected, typically with lobectomy and removal of the isthmus. — Diana Deason (guideline) [Ep 1 · 23:50](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1430)
- Frozen section cannot distinguish follicular adenoma from follicular carcinoma, but can identify papillary components. — Diana Deason (clinical) [Ep 1 · 25:04](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1504)
- For follicular carcinoma with significant vascular invasion or tumor greater than 4 cm, completion thyroidectomy is recommended; smaller tumors with minimal vascular invasion can be monitored. — Diana Deason (guideline) [Ep 1 · 26:10](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1570)
- About 30% of patients who undergo lobectomy may develop hypothyroidism at some point, so thyroid function monitoring is important even after partial thyroidectomy. — Diana Deason (epidemiological) [Ep 1 · 27:01](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1621)
- TSH suppression goals vary by ATA pediatric risk level: low-risk patients have a TSH goal of 0.5-1, while high-risk patients have a TSH goal of less than 0.1. — Diana Deason (guideline) [Ep 1 · 27:31](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1651)
- For benign thyroid nodules greater than 4 cm, the sensitivity and specificity of FNA is decreased, so it is important to follow these lesions with repeat ultrasound in 6-12 months and repeat biopsy if enlarging or developing suspicious features. — Diana Deason (clinical) [Ep 1 · 28:49](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1729)
- Inadequate FNA specimens occur in roughly 1-3% of cases and should be repeated in 3-6 months to avoid picking up atypia from trauma of the initial FNA. — Diana Deason (clinical) [Ep 1 · 29:49](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1789)
- Sporadic medullary thyroid cancer is unusual in children, so routine calcitonin monitoring is not recommended for every child with a thyroid nodule. — Diana Deason (guideline) [Ep 1 · 31:34](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1894)
- For medullary thyroid cancer, if initial calcitonin level is greater than 500, imaging should be performed to exclude metastatic disease, including CT of neck and chest, MRI or CT of abdomen (looking at liver), and bone scan. — Diana Deason (guideline) [Ep 1 · 33:01](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1981)
- MEN 2A patients can develop medullary thyroid cancer, pheochromocytomas, and hyperparathyroidism. — Diana Deason (clinical) [Ep 1 · 33:36](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2016)
- MEN 2B patients can develop medullary thyroid cancer, pheochromocytomas, mucosal neuromas, and a Marfanoid habitus with elongated features and joint laxity. — Diana Deason (clinical) [Ep 1 · 33:47](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2027)
- MEN 2B patients with RET 918 mutation present with thyroid cancer very early, as young as 3 months of age, and require thyroidectomy before 1 year of age. — Diana Deason (guideline) [Ep 1 · 34:11](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2051)
- MEN 2A high-risk patients (most commonly RET 634 mutation) should have total thyroidectomy before age 5, with surveillance starting at age 3 including calcitonin, CEA, and ultrasounds; if calcitonin or ultrasound abnormalities develop, thyroidectomy should be performed at that time. — Diana Deason (guideline) [Ep 1 · 36:03](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2163)
- If calcitonin levels exceed 40 in MEN patients undergoing surveillance, central neck dissection is recommended at the time of thyroidectomy. — Diana Deason (guideline) [Ep 1 · 36:27](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2187)
- Children under age 10 have increased risk of complications from thyroidectomy, including hypoparathyroidism and nerve injury, due to smaller anatomy and smaller parathyroid glands. — Diana Deason (clinical) [Ep 1 · 36:52](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2212)
- For MEN 2A moderate-risk patients, total thyroidectomy is recommended when serum calcitonin becomes elevated or if parents do not want to proceed with frequent surveillance. — Diana Deason (guideline) [Ep 1 · 36:59](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2219)
- MEN 2A moderate-risk patients do not tend to develop pheochromocytomas until their twenties or above, so screening begins at age 16; MEN 2A high-risk patients begin pheochromocytoma screening at age 11. — Diana Deason (guideline) [Ep 1 · 37:47](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2267)
- For prophylactic thyroidectomy in MEN patients, if performed before calcitonin levels exceed 40, central lymph node dissection is not necessary. — Diana Deason (guideline) [Ep 1 · 39:03](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2343)
- After thyroidectomy for medullary cancer, if calcitonin levels are undetectable or normal, surveillance includes physical exam and neck ultrasounds every 6 months for 1 year, then annually. — Diana Deason (guideline) [Ep 1 · 40:08](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2408)
- If postoperative calcitonin levels are greater than 150, imaging should be performed to detect metastasis, including CT neck and chest, MRI or CT abdomen, bone scan, and MRI of pelvis and axial skeleton. — Diana Deason (guideline) [Ep 1 · 40:22](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2422)
- Systemic therapy for medullary thyroid cancer (tyrosine kinase inhibitors, external beam radiation) has significant side effects and is reserved for patients with progressive disease not treatable with surgery, not for all patients with elevated calcitonin. — Diana Deason (guideline) [Ep 1 · 41:38](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2498)
- For Graves' disease in young children, thyroidectomy is often preferred over radioactive iodine due to concerns about risks of secondary malignancies from radioactive iodine. — Diana Deason (opinion) [Ep 1 · 42:29](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2549)
- Some pediatric patients with papillary thyroid cancer present with diffuse infiltration of the thyroid rather than a discrete nodule, often with clinically suspicious lymph nodes, which is a characteristic more common in children. — Diana Deason (clinical) [Ep 1 · 43:52](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2632)
- For pediatric patients with Bethesda 3 thyroid nodules, lobectomy is recommended rather than molecular testing or repeat FNA because there is a higher rate of malignancy in pediatric populations compared to adults — Ben Hamm (guideline) [Ep 2 · 0:52](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=52)
- For a nodule with intermediate risk of cancer (approximately 30%), thyroidectomy is not recommended because the patient probably only needs a hemithyroidectomy — Ben Hamm (clinical) [Ep 2 · 1:10](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=70)
- The 2015 pediatric guidelines recommend thyroid surgery being done by a high volume thyroid surgeon — Ben Hamm (guideline) [Ep 2 · 1:28](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=88)
- One recent study published the rate of recurrent laryngeal nerve injury decreasing from 8% to 1.5% with monitoring — Ben Hamm (clinical) [Ep 2 · 2:27](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=147)
- Studies in adults have shown that nerve monitoring helps identify the nerve more, but maybe doesn't change injury rates — Ben Hamm (clinical) [Ep 2 · 2:50](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=170)
- There are no studies in pediatrics showing significant decrease in injury rates with nerve monitoring, but there are several that show absolute decrease — Ben Hamm (clinical) [Ep 2 · 2:57](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=177)
- Recurrent laryngeal nerve injuries may happen more in children because it's a smaller nerve that may be harder to identify, with a rate of 9% in children versus about 6% in adults — Ben Hamm (epidemiological) [Ep 2 · 3:20](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=200)
- If injury is detected on one side with nerve monitoring, the surgeon may want to wait and see if it's just a transient thing that can recover later — Ben Hamm (clinical) [Ep 2 · 3:38](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=218)
- Expense is one consideration as a downside to nerve monitoring, and some have questioned its use if it doesn't change injury rates or outcomes — Ben Hamm (opinion) [Ep 2 · 3:49](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=229)
- Recent endotracheal tube electrode publications show nerve monitoring has been tried in children down to age 0 — Ben Hamm (clinical) [Ep 2 · 4:04](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=244)
- Nerve monitoring is most beneficial when doing a total thyroidectomy where the contralateral cord is paralyzed, to help decrease the risk of tracheotomy with bilateral paralysis — Ben Hamm (clinical) [Ep 2 · 4:28](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=268)
- If a child is too small for the 5.0 or 3.0 endotracheal tube electrodes, the electrodes come separate and can be placed directly into the vocalis muscle via direct laryngoscopy for monitoring (clinical) [Ep 2 · 4:40](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=280)
- A recent paper suggested that if you adjust the size criteria in TIRRADS, it actually performs better than the 2015 pediatric guidelines — Ben Hamm (clinical) [Ep 2 · 5:00](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=300)
- A larger institutional study through the Pediatric Surgical Oncology Research Collaborative using the modified PES-TIRRADS recommends biopsy for every TIRRADS 3 nodule over 1 cm or TIRRADS 4 or 5 over 0.5 cm (guideline) [Ep 2 · 5:13](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=313)
- For Bethesda 3 thyroid nodules in pediatrics, lobectomy is recommended rather than molecular testing or repeat FNA because there is a higher rate of malignancy in those populations compared to adults — Ben Hamm (guideline) [Ep 3 · 0:52](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=52)
- For an intermediate-risk thyroid nodule with approximately 30% cancer risk, hemithyroidectomy rather than total thyroidectomy is recommended — Ben Hamm (clinical) [Ep 3 · 1:10](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=70)
- The 2015 pediatric guidelines recommend thyroid surgery be performed by a high volume thyroid surgeon — Ben Hamm (guideline) [Ep 3 · 1:28](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=88)
- One recent study showed the rate of recurrent laryngeal nerve injury decreasing from 8% to 1.5% with nerve monitoring — Ben Hamm (epidemiological) [Ep 3 · 2:27](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=147)
- Studies in adults have shown nerve monitoring helps identify the nerve more, but maybe doesn't change injury rates — Ben Hamm (clinical) [Ep 3 · 2:50](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=170)
- There are no studies in pediatrics showing significant decrease in injury rates with nerve monitoring, but several show absolute decrease — Ben Hamm (clinical) [Ep 3 · 2:57](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=177)
- The recurrent laryngeal nerve is smaller in children and may be harder to identify — Ben Hamm (clinical) [Ep 3 · 3:22](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=202)
- The rate of recurrent laryngeal nerve injury in children is 9% versus about 6% in adults — Ben Hamm (epidemiological) [Ep 3 · 3:25](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=205)
- If injury is detected on one side with nerve monitoring, waiting to see if it's transient and can recover later may be appropriate — Ben Hamm (clinical) [Ep 3 · 3:38](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=218)
- Expense is one consideration as a downside to nerve monitoring — Ben Hamm (opinion) [Ep 3 · 3:47](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=227)
- Some have questioned why use nerve monitoring if it doesn't change injury rates or outcomes — Ben Hamm (opinion) [Ep 3 · 3:52](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=232)
- Recent endotracheal tube electrode publications report use in patients down to age 0 — Ben Hamm (clinical) [Ep 3 · 4:13](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=253)
- Nerve monitoring is most beneficial when doing a total thyroidectomy where the contralateral cord is at risk, to help decrease the risk of tracheotomy with bilateral paralysis — Ben Hamm (clinical) [Ep 3 · 4:28](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=268)
- If a child is too small for standard electrodes, electrodes can be placed directly into the vocalis muscle via direct laryngoscopy for monitoring (clinical) [Ep 3 · 4:40](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=280)
- A recent paper suggested that if size criteria are adjusted, TIRADS actually performs better than the 2015 pediatric guidelines — Ben Hamm (clinical) [Ep 3 · 5:00](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=300)
- The PES-TIRADS (modified version) recommends biopsy for every TIRADS 3 nodule over 1 cm or TIRADS 4/5 over 0.5 cm (guideline) [Ep 3 · 5:13](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=313)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- TIRRADS (Thyroid Imaging Reporting and Data System) is a scoring system developed for adults to stratify the risk of thyroid nodules based on ultrasound findings — Jill Knepprath summarizing the discussion [Ep 2 · 0:39](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=39)
- Thyroid nodules are more common in adults than in children, so there are not many centers that have a pediatric surgeon with high volume of these cases — Jill Knepprath summarizing the discussion [Ep 2 · 1:35](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=95)
- In thyroid surgery, intraoperative nerve monitoring is a technique to localize the recurrent laryngeal nerves which control the vocal cords using an electric probe to stimulate the nerve and EMG electrodes to monitor vocal cord movement — Jill Knepprath summarizing the discussion [Ep 2 · 2:14](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=134)
- In a recent survey, 80% of pediatric thyroid surgeons use nerve monitoring — Jill Knepprath summarizing the discussion [Ep 2 · 2:36](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=156)
- Nerve monitoring detects injury early, allowing surgeons to stage the operation and avoid bilateral injury, paralysis, and subsequent tracheotomy — Jill Knepprath summarizing the discussion [Ep 2 · 3:28](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=208)
- Nerve monitoring devices were often too big for pediatric patients — Jill Knepprath summarizing the discussion [Ep 2 · 3:58](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=238)
- Nerve monitoring can be considered in all pediatric thyroid surgeries because adhesive electrodes can be applied to even a 3.0 endotracheal tube — Jill Knepprath summarizing the discussion [Ep 2 · 4:18](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=258)
- Radiologists say that TIRRADS is not really reliable for pediatrics since it was originally developed for adults — Jill Knepprath summarizing the discussion [Ep 2 · 4:50](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=290)
- When criteria was based on the size of the thyroid relative to the size of the patient, no malignancies were missed — Jill Knepprath summarizing the discussion [Ep 2 · 5:27](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=327)
- Dr. Aldrin's 2025 study showed that the PES-TIRRADS eliminated unnecessary biopsies while not missing a single thyroid malignancy compared to adult and 2015 pediatric guidelines — Jill Knepprath summarizing the discussion [Ep 2 · 5:33](https://library.globalcastmd.com/watch/update-course-rewind-2025-nerve-monitoring-in-pediatric-thyroid-surgery-13577?t=333)
- Thyroid nodules are more common in adults than in children, resulting in few centers with pediatric surgeons having high volume of these cases — Jill Knepprath summarizing the discussion [Ep 3 · 1:35](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=95)
- In a recent survey, 80% of pediatric thyroid surgeons use nerve monitoring — Jill Knepprath summarizing the discussion [Ep 3 · 2:36](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=156)
- Nerve monitoring detects injury early, allowing surgeons to stage the operation and avoid bilateral injury, paralysis, and subsequent tracheotomy — Jill Knepprath summarizing the discussion [Ep 3 · 3:29](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=209)
- Nerve monitoring devices were often too big for pediatric patients historically — Jill Knepprath summarizing the discussion [Ep 3 · 3:58](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=238)
- Adhesive electrodes can be applied to even a 3.0 endotracheal tube, allowing nerve monitoring in all pediatric thyroid surgeries — Jill Knepprath summarizing the discussion [Ep 3 · 4:18](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=258)
- Radiologists say TIRADS is not reliable for pediatrics since it was originally developed for adults — Jill Knepprath summarizing the discussion [Ep 3 · 4:50](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=290)
- When criteria was based on the size of the thyroid relative to the size of the patient, no malignancies were missed — Jill Knepprath summarizing the discussion [Ep 3 · 5:27](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=327)
- Dr. Aldrin's 2025 study showed that PES-TIRADS eliminated unnecessary biopsies while not missing a single thyroid malignancy compared to adult and 2015 pediatric guidelines — Jill Knepprath summarizing the discussion [Ep 3 · 5:33](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=333)

## Changelog
- Nov 11: 3 items added automatically

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