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Thyroid Nodule
Everything in the library about thyroid nodule — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
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Surgical Management
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2025 Pediatric Surgery Update Course - Nerve Monitoring and Stimulation in Pediatric Surgery
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On August 26th, the largest Pediatric Surgery course in the world each year was held, where top hospital experts from around the US will discuss this year’s changes in practices and innovation. Learn more about the future of pediatric surge
video16:39 · Aug 2025
Update Course Rewind 2025: Nerve Monitoring in Pediatric Thyroid Surgery
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This video recaps key highlights from the 13th Annual Pediatric Surgery Update Course, focusing on nerve monitoring in pediatric thyroid surgery. Dr. Ben Ham discuss clinical scenarios, the utility of TI-RADS in children, and the role of in
video6:20 · Jul 2026
In-Depth Reviews
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Thyroid Disorders
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An interactive discussion about malignant and benign pediatric thyroid disorders between Todd Ponsky, MD and Diana Diesen, MD. Dr. Diesen is assistant professor of surgery and pediatric surgery fellowship program director at the University
podcast45:51 · Dec 2020
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Thyroid Disorders
Thyroid nodules are less common in children than adults, but when detected in children, they are more likely to be malignant.
epidemiologicalDiana Deason6:23 ↗
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.
clinicalDiana Deason6:31 ↗
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.
clinicalDiana Deason4:08 ↗
Some thyroid conditions and thyroid cancers have familial predisposition, including MEN syndromes, PTEN hamartoma tumor syndromes, and APC-associated polyposis syndromes.
clinicalDiana Deason4:27 ↗
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.
guidelineDiana Deason7:24 ↗
Suspicious ultrasound features for thyroid malignancy include hypoechoic mass, irregular margins, increased blood flow, microcalcifications, or association with abnormal lymph nodes.
clinicalDiana Deason9:57 ↗
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.
guidelineDiana Deason11:21 ↗
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.
guidelineDiana Deason15:00 ↗
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.
opinionDiana Deason17:07 ↗
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.
guidelineDiana Deason18:33 ↗
After total thyroidectomy, PTH levels less than 10 to 15 in recovery indicate higher risk for hypocalcemia, prompting initiation of calcium replacement or calcitriol.
clinicalDiana Deason19:37 ↗
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.
guidelineDiana Deason21:12 ↗
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.
guidelineDiana Deason21:48 ↗
Follicular lesions represent about one-third of thyroid FNA results and are indeterminate specimens.
epidemiologicalDiana Deason23:05 ↗
For follicular lesions of undetermined significance, the risk of malignancy in adults is 5-15%, but in pediatric literature it is approximately 28%.
epidemiologicalDiana Deason24:07 ↗
For follicular neoplasms, the reported malignancy rate was 15-30%, but more recent data suggests it is between 50% and 60% in children.
epidemiologicalDiana Deason24:18 ↗
Current ATA recommendations are that all indeterminate (follicular) lesions in children be resected, typically with lobectomy and removal of the isthmus.
guidelineDiana Deason23:50 ↗
Frozen section cannot distinguish follicular adenoma from follicular carcinoma, but can identify papillary components.
clinicalDiana Deason25:04 ↗
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.
guidelineDiana Deason26:10 ↗
About 30% of patients who undergo lobectomy may develop hypothyroidism at some point, so thyroid function monitoring is important even after partial thyroidectomy.
epidemiologicalDiana Deason27:01 ↗
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.
guidelineDiana Deason27:31 ↗
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.
clinicalDiana Deason28:49 ↗
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.
clinicalDiana Deason29:49 ↗
Sporadic medullary thyroid cancer is unusual in children, so routine calcitonin monitoring is not recommended for every child with a thyroid nodule.
guidelineDiana Deason31:34 ↗
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.
guidelineDiana Deason33:01 ↗
MEN 2A patients can develop medullary thyroid cancer, pheochromocytomas, and hyperparathyroidism.
clinicalDiana Deason33:36 ↗
MEN 2B patients can develop medullary thyroid cancer, pheochromocytomas, mucosal neuromas, and a Marfanoid habitus with elongated features and joint laxity.
clinicalDiana Deason33:47 ↗
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.
guidelineDiana Deason34:11 ↗
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.
guidelineDiana Deason36:03 ↗
If calcitonin levels exceed 40 in MEN patients undergoing surveillance, central neck dissection is recommended at the time of thyroidectomy.
guidelineDiana Deason36:27 ↗
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