Paeds · endocrinology-diabetes-and-growth
Thyroid nodules, goitre and thyroid cancer
Also known as Paediatric thyroid nodule · Childhood thyroid cancer · Differentiated thyroid carcinoma in children · Papillary thyroid carcinoma in children · Paediatric goitre · Medullary thyroid carcinoma in children
Fellowship guide to paediatric thyroid nodules, goitre and thyroid cancer: recognise the neck mass, risk-stratify with ultrasound (TI-RADS) and FNA (Bethesda), understand the higher childhood malignancy risk and gene-fusion biology, and step through multidisciplinary surgery, risk-adapted radioiodine and surveillance.
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Target exams
Red flags
- Rapidly growing, firm or fixed thyroid mass with new hoarse voice or vocal cord palsy — urgent imaging, FNA and ENT referral; compressive stridor is an airway emergency
- Palpable cervical lymphadenopathy alongside a thyroid nodule — malignancy until proven otherwise; biopsy the node and the nodule
- Prior neck radiotherapy for a childhood cancer — thyroid nodules carry substantially higher malignancy risk; surveillance ultrasound is mandatory
- Elevated calcitonin or family history of medullary thyroid carcinoma / MEN2 — think germline RET; refer for genetic counselling before surgery
- Dysphagia, stridor or superior vena cava-type features from a large goitre or mass — compressive symptoms need urgent imaging and airway assessment
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Endocrinology and growth
- Thyroid nodules and thyroid cancer in children
- Current 2026 PREP curriculum — Learning goal 5: Clinical assessment – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 5: Clinical assessment – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 12: Communication with patients, families, and health professionals
- Endocrinology and adolescent medicine competencies
- Clinical Applications
- Endocrinology
- Long Cases
- Short Cases
- 4. Professional skills and knowledge: Patient management
- 5. Professional skills and knowledge: Health promotion and illness prevention
- General Paediatrics: Investigates and manages thyroid disorders and neck masses
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Clinical
- History
- Communication
- Endocrine and growth assessment
- General Pediatrics Content Outline — Domain 9: Endocrine Disorders
- General Pediatrics Content Outline — Domain 13: Oncologic Disorders
- General Pediatrics EPA: Assess and manage common neck masses and thyroid nodules
- Patient Care 1: History and Physical Examination
- Patient Care 4: Clinical Reasoning
- Medical Knowledge 1: Clinical Knowledge
- Systems-Based Practice: multidisciplinary tumour board and transition coordination
- Medical Expert
- Communicator
- Collaborator
- Pediatrics: Foundations EPA — Recognising and managing thyroid nodules and neck masses
- Pediatrics: Core EPA — Coordinating multidisciplinary cancer care
Overview & Definition
Picture the teenager who finds a lump in the shower, or the school-age child whose paediatrician notices an asymmetric swelling on routine examination. Most such thyroid nodules are benign, yet a general paediatrician must move each one through a defined pipeline rather than watch and wait blindly, because childhood nodules carry a malignancy risk of roughly 20–25% — about twice the adult figure. [1] [5]
A thyroid nodule is a discrete focal lesion within the thyroid, distinguishable from the surrounding parenchyma on ultrasound. A goitre describes enlargement of the whole gland and may be diffuse (uniform) or multinodular. Thyroid cancer in children is overwhelmingly differentiated thyroid carcinoma (DTC), of which papillary thyroid carcinoma (PTC) accounts for the large majority; follicular and medullary subtypes are far less common but change management decisively. [1] [4]
The reason this leaf matters for a fellowship candidate is that the paediatric landscape is genuinely different from the adult one: higher pretest probability of malignancy, a different molecular driver profile (gene fusions rather than point mutations), more extensive disease at presentation yet markedly better survival, and a long surveillance horizon that spans the transition to adult care. [4] [7] [17]
References21ShowHide
- [1]Francis GL Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 2015.PMID 25900731
- [2]Tessler FN ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. Journal of the American College of Radiology, 2017.PMID 28372962
- [3]Tessler FN Thyroid Imaging Reporting and Data System (TI-RADS): A User's Guide. Radiology, 2018.PMID 29558300
- [4]Vergamini LB Increase in the incidence of differentiated thyroid carcinoma in children, adolescents, and young adults: a population-based study. The Journal of Pediatrics, 2014.PMID 24630354
- [5]Goldfarb M Differences in the management of thyroid nodules in children and adolescents as compared with adults. Current Opinion in Endocrinology, Diabetes and Obesity, 2022.PMID 35777975
- [6]Goldfarb M Survivorship, Quality of Life, and Transition to Adult Care for Pediatric and Adolescent Thyroid Cancer. Thyroid, 2022.PMID 36193568
- [7]Hay ID Papillary Thyroid Carcinoma (PTC) in Children and Adults: Comparison of Initial Presentation and Long-Term Postoperative Outcomes. World Journal of Surgery, 2018.PMID 29030676
- [8]Hay ID Long-term Effectiveness of Ethanol Ablation in Controlling Neck Nodal Metastases in Childhood Papillary Thyroid Carcinoma. Journal of the Endocrine Society, 2023.PMID 37388573
- [9]Kothari R Composition and Priorities of Multidisciplinary Pediatric Thyroid Programs: A Consensus Statement. Thyroid, 2025.PMID 39950999
- [10]Mollen KP Unique Molecular Signatures Are Associated with Aggressive Histology in Pediatric Differentiated Thyroid Carcinoma. Thyroid, 2022.PMID 34915753
- [11]Wasserman JD The Landscape of Pediatric Differentiated Thyroid Carcinoma and Predictors of Invasive Disease. The Journal of Clinical Endocrinology and Metabolism, 2026.PMID 42025318
- [12]Spaulding SL Molecular Genetics Augment Cytopathologic Evaluation and Surgical Planning of Pediatric Thyroid Nodules. Journal of Pediatric Surgery, 2024.PMID 38246817
- [13]Wells SA Jr Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid, 2015.PMID 25810047
- [14]Hensley SG Pediatric Medullary Thyroid Carcinoma: Clinical Presentations and Long-Term Outcomes. The Journal of Clinical Endocrinology and Metabolism, 2024.PMID 38441533
- [15]Yu J Comparison of ultrasound risk stratification systems for pediatric thyroid nodules. Frontiers in Endocrinology, 2024.PMID 38572472
- [16]Srivatsa S Assessing the Diagnostic Accuracy of TI-RADS in Pediatric Thyroid Nodules: A Multi-Institutional Study. Journal of Pediatric Surgery, 2025.PMID 39358076
- [17]Pillai SS Evolving trends in pediatric thyroid nodules and cancer management. Annals of Pediatric Endocrinology and Metabolism, 2026.PMID 42415554
- [18]Gest-Laurent M Clinical, Radiologic and Cytologic Predictors of Malignancy in Pediatric Thyroid Nodules. Head & Neck, 2026.PMID 42403156
- [19]Scott AR Trends in Cancer Incidence in US Adolescents and Young Adults, 1973-2015. JAMA Network Open, 2020.PMID 33258907
- [20]Bukarica S Thyroid Surgery in Children: A 5-Year Retrospective Study at a Single Paediatric Institution. Children, 2022.PMID 36553262
- [21]Castinetti F Natural history, treatment, and long-term follow up of patients with multiple endocrine neoplasia type 2. The Lancet Diabetes and Endocrinology, 2019.PMID 30660595