This presentation will provide an overview of the 2022 European Thyroid Association (ETA) Guidelines for the management of pediatric thyroid nodules and differentiated thyroid carcinoma (DTC). The guidelines emphasize the need for a pediatric-specific approach, recognizing that thyroid disease in children and adolescents differs significantly from cases in adults, in terms of the presentation, biology, and long-term prognosis.

Although relatively rare, pediatric thyroid nodules carry a higher risk of malignancy. The guidelines recommend a careful and structured diagnostic process, including a detailed ultrasound evaluation and the selective use of fine-needle aspiration (FNA) guided by a risk stratification system based on clinical and sonographic features. Molecular testing can inform decision-making in some cases.

Treatment strategies focus on balancing effective oncological control with the patient's long-term wellbeing. Total thyroidectomy is the standard procedure for most cases of pediatric DTC, particularly when there is evidence of multifocality or lymph node involvement. However, the guidelines recommend more conservative surgical options, such as lobectomy, for select low-risk patients. The approach to radioactive iodine (RAI) therapy has also become more conservative, with greater emphasis placed on avoiding unnecessary exposure in low-risk cases.

Lifelong follow-up is recommended due to the potential for recurrence and the subsequent effects of treatment. The guidelines emphasize the importance of a multidisciplinary team, ensuring that surgical, endocrinological, radiological, and psychosocial expertise is integrated into the care of each patient.

By following these recommendations, healthcare providers can aim for optimal outcomes while minimizing long-term harm, ensuring both effective cancer treatment and preservation of quality of life for pediatric patients.

1. Lebbink CA, Links TP, Czarniecka A, Dias RP, Elisei R, Izatt L, et al. 2022 European Thyroid Association Guidelines for the management of pediatric thyroid nodules and differentiated thyroid carcinoma. Eur Thyroid J 2022; 11: e220146. https://doi. org/10.1159/000526130.