title: Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer.
abstract: BACKGROUND
  Previous guidelines for the management of thyroid nodules and cancers were geared toward adults. Compared with thyroid neoplasms in adults, however, those in the pediatric population exhibit differences in pathophysiology, clinical presentation, and long-term outcomes. Furthermore, therapy that may be recommended for an adult may not be appropriate for a child who is at low risk for death but at higher risk for long-term harm from overly aggressive treatment. For these reasons, unique guidelines for children and adolescents with thyroid tumors are needed.
  
  
  METHODS
  A task force commissioned by the American Thyroid Association (ATA) developed a series of clinically relevant questions pertaining to the management of children with thyroid nodules and differentiated thyroid cancer (DTC). Using an extensive literature search, primarily focused on studies that included subjects ≤18 years of age, the task force identified and reviewed relevant articles through April 2014. Recommendations were made based upon scientific evidence and expert opinion and were graded using a modified schema from the United States Preventive Services Task Force.
  
  
  RESULTS
  These inaugural guidelines provide recommendations for the evaluation and management of thyroid nodules in children and adolescents, including the role and interpretation of ultrasound, fine-needle aspiration cytology, and the management of benign nodules. Recommendations for the evaluation, treatment, and follow-up of children and adolescents with DTC are outlined and include preoperative staging, surgical management, postoperative staging, the role of radioactive iodine therapy, and goals for thyrotropin suppression. Management algorithms are proposed and separate recommendations for papillary and follicular thyroid cancers are provided.
  
  
  CONCLUSIONS
  In response to our charge as an independent task force appointed by the ATA, we developed recommendations based on scientific evidence and expert opinion for the management of thyroid nodules and DTC in children and adolescents. In our opinion, these represent the current optimal care for children and adolescents with these conditions.
authors.affiliation: 1 Division of Pediatric Endocrinology, Virginia Commonwealth University , Children's Hospital of Richmond, Richmond, Virginia.
authors.forename: Gary L
authors.initials: GL
authors.lastname: Francis
authors.affiliation: 2 Department of Endocrine Neoplasia and Hormonal Disorders and Department of Pediatrics-Patient Care, Children's Cancer Hospital, University of Texas MD Anderson Cancer Center , Houston, Texas.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Waguespack
authors.affiliation: 3 Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania.|4 Department of Pediatrics, The University of Pennsylvania , The Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Bauer
authors.affiliation: 5 Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine , Chicago, Illinois.
authors.forename: Peter
authors.initials: P
authors.lastname: Angelos
authors.affiliation: 6 University of Messina , Interdepartmental Program on Clinical & Molecular Endocrinology, and Women's Endocrine Health, A.O.U. Policlinico Universitario G. Martino, Messina, Italy .
authors.forename: Salvatore
authors.initials: S
authors.lastname: Benvenga
authors.affiliation: 7 Department of Morphology and Genetics. Division of Genetics, Federal University of São Paulo , São Paulo, Brazil .
authors.forename: Janete M
authors.initials: JM
authors.lastname: Cerutti
authors.affiliation: 8 Department of Surgery, Division of Pediatric Surgery, Department of Pediatrics, Division of Pediatric Endocrinology, Yale University School of Medicine , New Haven, Connecticut.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Dinauer
authors.affiliation: 9 Division of Endocrinology, University of Toronto , Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada .
authors.forename: Jill
authors.initials: J
authors.lastname: Hamilton
authors.affiliation: 10 Division of Endocrinology, Mayo Clinic and College of Medicine , Rochester, Minnesota.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Hay
authors.affiliation: 11 University of Marburg , Marburg, Germany .|12 Department of Nuclear Medicine, University Hospital Marburg , Marburg, Germany .
authors.forename: Markus
authors.initials: M
authors.lastname: Luster
authors.affiliation: 13 Departments of Radiology and Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital , Department of Radiology, Seattle, Washington.
authors.forename: Marguerite T
authors.initials: MT
authors.lastname: Parisi
authors.affiliation: 14 Pediatric Division, Assaf Haroffeh Medical Center , Zerifin, Israel .|15 Sackler School of Medicine, Tel Aviv University , Tel Aviv, Israel .
authors.forename: Marianna
authors.initials: M
authors.lastname: Rachmiel
authors.affiliation: 16 Department of Surgery, Division of Subspecialty GS (General Surgery), Mayo Clinic , Rochester, Minnesota.
authors.forename: Geoffrey B
authors.initials: GB
authors.lastname: Thompson
authors.affiliation: 17 Atomic Bomb Disease Institute, Nagasaki University , Nagasaki, Japan .
authors.forename: Shunichi
authors.initials: S
authors.lastname: Yamashita
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000175:diagnosis / Q000628:therapy*; D018249:Adenoma, Oxyphilic; D000293:Adolescent; D044963:Biopsy, Fine-Needle; D002277:Carcinoma / Q000175:diagnosis / Q000628:therapy*; D002291:Carcinoma, Papillary; D002648:Child; D019468:Disease Management; D006801:Humans; D012955:Societies, Medical; D000077273:Thyroid Cancer, Papillary; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000473:pathology*; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000628:therapy*; D016606:Thyroid Nodule / Q000175:diagnosis / Q000628:therapy*; D014463:Ultrasonography; D014481:United States